Owen, CG; Rudnicka, AR; Welikala, RA; Fraz, MM; Barman, SA; Luben, R; Hayat, SA; ... Foster, PJ; + view all Owen, CG; Rudnicka, AR; Welikala, RA; Fraz, MM; Barman, SA; Luben, R; Hayat, SA; Khaw, K-T; Strachan, DP; Whincup, PH; Foster, PJ; - view fewer (2019) Retinal vasculometry associations with cardiometabolic risk factors in the European Prospective Investigation of Cancer Norfolk study. Ophthalmology , 126 (1) pp. 96-106. 10.1016/j.ophtha.2018.07.022.

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Abstract

PURPOSE: To examine associations between retinal vessel morphometry and cardiometabolic risk factors in older British men and women. DESIGN: Retinal imaging examination as part of the European Prospective Investigation into Cancer-Norfolk Eye study. PARTICIPANTS: 7411 participants underwent retinal imaging and clinical assessment. Retinal images were analysed using a fully automated validated computerised system, which provides novel measures of vessel morphometry. METHODS: Associations between cardiometabolic risk factors, chronic disease and retinal markers were analyzed using multi-level linear regression, adjusted for age, sex and within person clustering, to provide percentage differences in tortuosity and absolute differences in width. MAIN OUTCOMES MEASURES: Retinal arteriolar and venular tortuosity and width. RESULTS: 279,802 arterioles, and 285,791 venules from 5947 participants (mean age 67.6 years, SD 7.6, 57% female) were analysed. Increased venular tortuosity was associated with higher BMI (2.5%, 95% CI 1.7,3.3% per 5 kg/m2) and HbA1c (2.2%, 95%CI 1.0,3.5% per %), and with prevalent type 2 diabetes (6.5%, 95%CI 2.8,10.4%); wider venules were associated with older age (2.6μm, 95%CI 2.2,2.9μm per decade), higher triglycerides (0.6μm, 95%CI 0.3,0.9μm per mmol/L), BMI (0.7μm, 95%CI 0.4,1.0 per 5 kg/m2) and HbA1c (0.4μm, 95%CI -0.1,0.9 per %) and being a current smoker (3.0μm, 95%CI 1.7,4.3μm); similarly smoking was also associated with wider arterioles (2.1μm, 95%CI 1.3,2.9μm). Thinner venules were associated with HDL (1.4μm, 95%CI 0.7,2.2 per mmol/L). Arteriolar tortuosity increased with age (5.4%, 95%CI 3.8,7.1% per decade), higher systolic blood pressure (1.2%, 95%CI 0.5,1.9% per 10mmHg), in females (3.8, 95%CI 1.4,6.4%) and with prevalent stroke (8.3%, 95%CI -0.6,18%); no association was observed with prevalent myocardial infarction. Narrower arterioles were associated with age (0.8μm, 95%CI 0.6,1.0μm per decade), higher systolic blood pressure (0.5μm, 95%CI 0.4,0.6μm per 10mmHg), total cholesterol (0.2μm, 95%CI 0.0,0.3μm per mmol/L) and HDL (1.2μm, 95%CI 0.7,1.6μm per mmol/L). CONCLUSIONS: Metabolic risk factors show a graded association with both tortuosity and width of retinal venules, even among people without clinical diabetes, whereas atherosclerotic risk factors correlate more closely with arteriolar width, even excluding those with hypertension and cardiovascular disease. These non-invasive microvasculature measures should be evaluated further as predictors of future cardiometabolic disease among apparently healthy individuals.

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