This Article Full Text Full Text (PDF) All Versions of this Article: 37/7/1833    most recent 01.STR.0000226929.23297.75v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, J. J. Articles by Mitchell, P. Search for Related Content PubMed PubMed Citation Articles by Wang, J. J. Articles by Mitchell, P. Pubmed/NCBI databases Medline Plus Health Information Retinal Disorders Related Collections Epidemiology Other imaging Risk Factors for Stroke

(Stroke. 2006;37:1833.)
© 2006 American Heart Association, Inc.

Original Contributions

Retinal Arteriolar Emboli and Long-Term Mortality

Pooled Data Analysis From Two Older Populations

Jie Jin Wang, MMed, PhD; Sudha Cugati, MS; Michael D. Knudtson, MS; Elena Rochtchina, MApplStat; Ronald Klein, MD, MPH; Barbara E.K. Klein, MD, MPH; Tien Yin Wong, MPH, PhD Paul Mitchell, MD, PhD

From the University of Sydney Department of Ophthalmology (J.J.W., S.C., E.R., P.M.), Centre for Vision Research, Westmead Hospital, the Westmead Millennium Institute, Australia; Department of Ophthalmology and Visual Sciences (M.D.K., R.K., B.E.K.K.), University of Wisconsin School of Medicine and Public Health, Madison; Centre for Eye Research Australia (T.Y.W.), University of Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), National University of Singapore.

Correspondence to Jie Jin Wang, Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Hawkesbury Rd, Westmead, NSW Australia, 2145. E-mail jiejin_wang{at}wmi.usyd.edu.au

Background and Purpose— To assess the relationship between retinal arteriolar emboli and mortality in older people.

Methods— Pooled data from 2 population-based cohort studies. At baseline, the Beaver Dam Eye Study (BDES) examined 4926 persons 43 to 86 years of age (1988 to 1990), and the Blue Mountains Eye Study (BMES) examined 3654 persons 49 to 97 years of age (1992 to 1994). Retinal arteriolar emboli were assessed by grading retinal photographs using standardized methods. Deaths and causes of death were determined from death certificates or Australian National Death Index. Cox regression models were used to estimate mortality hazard ratios (HRs) associated with emboli, adjusting for age, gender, body mass index, hypertension, diabetes, smoking, serum total cholesterol, high-density lipoprotein cholesterol, study site, and past histories of stroke, angina, and acute myocardial infarct.

Results— Of 8580 baseline participants, 8384 (98%) had retinal photographs available, and 111 showed retinal arteriolar emboli (BDES n=61; BMES n=50). Over 10 to 12 years, 2506 participants (30%) died, including 344 (4%) from stroke-related and 1315 (16%) from cardiovascular causes. The cumulative mortality rates were higher in participants with than without emboli (all-cause 56% versus 30%; stroke-related 12% versus 4.0%; cardiovascular 30% versus 16%). The increased mortality risk associated with emboli was independent of age, gender, other vascular risk factors, and past histories of stroke or heart disease for all-cause (multivariate-adjusted HR, 1.3; CI, 1.0 to 1.8) and stroke-related mortality (HR, 2.0; CI, 1.1 to 3.8) but not for cardiovascular mortality (HR, 1.2; CI, 0.8 to 1.7).

Conclusions— Our pooled data from 2 older populations suggest that retinal emboli predict a modest increase in all-cause and stroke-related mortality independent of cardiovascular risk factors.

Key Words: epidemiology • mortality • prognosis • stroke

This article has been cited by other articles:

				D. A. De Silva, T. Y. Wong, H.-M. Chang, B.-F. Ng, G. Tikellis, S. M. Saw, F.-P. Woon, C. P.L.H. Chen, and M.-C. Wong Is Routine Retinal Examination Useful in Patients With Acute Ischemic Stroke? Stroke, April 1, 2008; 39(4): 1352 - 1354. [Abstract] [Full Text] [PDF]

				M. L. Baker, P. J. Hand, J. J. Wang, and T. Y. Wong Retinal Signs and Stroke: Revisiting the Link Between the Eye and Brain Stroke, April 1, 2008; 39(4): 1371 - 1379. [Abstract] [Full Text] [PDF]

				J. J. Wang, G. Liew, R. Klein, E. Rochtchina, M. D. Knudtson, B. E.K. Klein, T. Y. Wong, G. Burlutsky, and P. Mitchell Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations Eur. Heart J., August 2, 2007; 28(16): 1984 - 1992. [Abstract] [Full Text] [PDF]