Kevin McGeechan, MBiostat; Gerald Liew, MBBS, MMed; Petra Macaskill, PhD; Les Irwig, MBBCh, PhD; Ronald Klein, MD, MPH; Barbara E.K. Klein, MD, MPH; Jie Jin Wang, MMed, PhD; Paul Mitchell, MD, PhD; Johannes R. Vingerling, MD, PhD; Paulus T.V.M. deJong, MD, PhD; Jacqueline C.M. Witteman, PhD; Monique M.B. Breteler, MD, PhD; Jonathan Shaw, MD; Paul Zimmet, MD; Tien Y. Wong, MD, PhD
Note: A full list of principal CHS investigators and institutions can be found at www.chs-nhlbi.org/pi.htm.
Acknowledgment: The authors thank Ruth Mitchell, Trials Search Co-ordinator, Cochrane Renal Group, Centre for Kidney Research, Children's Hospital at Westmead, Australia, for her advice on the construction of the MEDLINE and EMBASE search strategies. The authors also thank the staff and participants of the ARIC Study for their important contributions.
Grant Support: By the Australian National Health and Medical Research Council (program grants 402764 and 358395) and the National Heart, Lung, and Blood Institute (contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, and N01-HC-45133 and grant U01 HL080295), with additional contributions from the National Institute of Neurological Disorders and Stroke. The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Tien Y. Wong, MD, PhD, Singapore Eye Research Institute, National University of Singapore, 11 Third Hospital Avenue, Singapore 168751, Singapore; e-mail, email@example.com.
Current Author Addresses: Mr. McGeechan and Drs. Macaskill and Irwig: School of Public Health, Edward Ford Building (A27), The University of Sydney, New South Wales 2006, Australia.
Drs. Liew, Wang, and Mitchell: Centre for Vision Research, Department of Ophthalmology, University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, New South Wales 2145, Australia.
Drs. R. Klein and B. Klein: University of Wisconsin–Madison, Department of Ophthalmology and Visual Sciences, 610 North Walnut Street, Madison, WI 53726.
Drs. Vingerling, Witteman, and Breteler: Department of Epidemiology and Biostatistics, Erasmus Medical Center, Postbus 2040, 3000CA Rotterdam, Netherlands.
Dr. deJong: Department of Ophthalmology, Erasmus Medical Center, Postbus 2040, 3000CA Rotterdam, Netherlands.
Drs. Shaw and Zimmet: Baker IDI Heart and Diabetes Institute, Box 6492, Saint Kilda Road Central, Victoria 8008, Australia.
Dr. Wong: Singapore Eye Research Institute, National University of Singapore, 11 Third Hospital Avenue, Singapore 168751, Singapore.
McGeechan K., Liew G., Macaskill P., Irwig L., Klein R., Klein B., Wang J., Mitchell P., Vingerling J., deJong P., Witteman J., Breteler M., Shaw J., Zimmet P., Wong T.; Meta-analysis: Retinal Vessel Caliber and Risk for Coronary Heart Disease. Ann Intern Med. 2009;151:404-413. doi: 10.7326/0003-4819-151-6-200909150-00005
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Published: Ann Intern Med. 2009;151(6):404-413.
Retinal vessel caliber may be a novel marker of coronary heart disease (CHD) risk. However, the sex-specific effect, magnitude of association, and effect independent of traditional CHD disease risk factors remain unclear.
To determine the association between retinal vessel caliber and risk for CHD.
Relevant studies in any language identified through MEDLINE (1950 to June 2009) and EMBASE (1950 to June 2009) databases.
Studies were included if they examined a general population, measured retinal vessel caliber from retinal photographs, and documented CHD risk factors and incident CHD events.
6 population-based prospective cohort studies provided data for individual participant meta-analysis.
Proportional hazards models, adjusted for traditional CHD risk factors, were constructed for retinal vessel caliber and incident CHD in women and men. Among 22Â 159 participants who were free of CHD and followed for 5 to 14 years, 2219 (10.0%) incident CHD events occurred. Retinal vessel caliber changes (wider venules and narrower arterioles) were each associated with an increased risk for CHD in women (pooled multivariable-adjusted hazard ratios, 1.16 [95% CI, 1.06 to 1.26] per 20-Î¼m increase in venular caliber and 1.17 [CI, 1.07 to 1.28] per 20-Î¼m decrease in arteriolar caliber) but not in men (1.02 [CI, 0.94 to 1.10] per 20-Î¼m increase in venular caliber and 1.02 [CI, 0.95 to 1.10] per 20-Î¼m decrease in arteriolar caliber). Women without hypertension or diabetes had higher hazard ratios.
Error in the measurement of retinal vessel caliber and Framingham variables was not taken into account.
Retinal vessel caliber changes were independently associated with an increased risk for CHD events in women.
Ghanshyam Palamaner Subash Shantha
Sri Ramachandra University, Chennai, India
September 26, 2009
Retinal changes can predict both acute and chronic coronary artery disease
We read with interest the review article by McGeechan et al. (1). From this prospective study they concluded that retinal vessel caliber changes were independently associated with an increased risk for CHD events in women. We recently concluded a cross-sectional study where we analyzed the utility of hypertensive retinal changes in predicting coronary artery disease among elderly hypertensive patients (aged > 65years) who presented to the emergency room with unstable angina (2). Hypertensive retinal changes had a likelihood ratio of a positive test (LR+) and likelihood ratio of negative test (LR-) of 3.92 and 0.52 respectively in predicting coronary artery disease. Hence we concluded that hypertensive retinal changes had a moderate accuracy in predicting coronary artery disease and hence can be used as a cost effective screening tool. We thought we will share our experience just to emphasize the point that retinal examination should be made mandatory in the assessment of hypertensive patients. They are useful in the assessment of both acute and chronic CHD.
1) McGeechan K, Liew G, Macaskill P, Irwig L, Klein R, Klein BE, Wang JJ, Mitchell P, Vingerling JR, Dejong PT, Witteman JC, Breteler MM, Shaw J, Zimmet P, Wong TY. Meta-analysis: retinal vessel caliber and risk for coronary heart disease. Ann Intern Med. 2009; 151(6):404-13.
2) Shantha GP, Srinivasan Y, Kumar AA, Salim S, Prabakhar S, Rajan AG, Muralidharan TR, Can retinal changes predict coronary artery disease in elderly hypertensives presenting with angina. American Journal of Emergency Medicine, In press.
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Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors, Coronary Heart Disease.
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