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From the Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium and Save Sight Institutes (Drs. Mitchell and Wang), and Faculty of Medicine (Dr. Leeder), University of Sydney, Australia; Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne (Dr. Wong); Singapore National Eye Centre and National University of Singapore (Dr. Wong); Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia (Dr. Smith); and Department of Ophthalmology and Visual Science, University of Wisconsin-Madison (Dr. Klein).
Address correspondence and reprint requests to Dr. Paul Mitchell, Department of Ophthalmology, University of Sydney, Hawkesbury Road, Westmead, NSW Australia, 2145; e-mail: paul_mitchell{at}wmi.usyd.edu.au
Objective: The purpose of this study was to assess the relation of retinal microvascular signs and incident stroke and stroke mortality in an older population.
Methods: The authors took retinal photographs on baseline participants (3,654 patients aged 49+ years) of the Blue Mountains Eye Study (1992 to 1994). They assessed the presence of retinopathy (microaneurysms, retinal hemorrhages) in participants without diabetes and retinal arteriolar signs in all participants using standardized grading protocols. Incident stroke/TIA/cerebrovascular death (combined stroke events) were identified at follow-up examinations during 1997 to 1999.
Results: During a 7-year period, 859 participants died, 97 (11.3%) of which died of cerebrovascular causes. Of survivors, 24 had confirmed incident stroke, and 11 had incident TIA. Combined stroke events were more frequent in participants with retinopathy (5.7%), with moderate/severe arteriovenous nicking (4.2%), or with focal arteriolar narrowing (7.2%) compared with those without (1.9%). After controlling for age, sex, systolic blood pressure, smoking, and self-rated health, retinopathy was significantly associated with combined stroke events (relative risk [RR] 1.7, 95% CI 1.0 to 2.8) in persons without diabetes. This association was stronger in those without severe hypertension (RR 2.7, CI 1.2 to 6.2) or in persons with two or more retinal microvascular signs (RR 2.7, CI 1.5 to 5.2). Generalized or focal arteriolar narrowing or arteriovenous nicking was not independently associated with combined stroke events after multivariate adjustment.
Conclusions: In older Australians without diabetes, retinopathy signs predict stroke or stroke-related death independent of traditional stroke risk factors.
Disclosure: The authors report no conflicts of interest.
Received October 28, 2004. Accepted in final form June 15, 2005.
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