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From the Departments of Epidemiology & Biostatistics (M.K.I., F.J.d.J., M.J.B., J.R.V., A.H., P.T.V.M.d.J., M.M.B.B.), Ophthalmology (J.R.V.), and Neurology (M.K.I., P.J.K.), Erasmus Medical Center, Rotterdam; The Netherlands Institute for Neurosciences (P.T.V.M.d.J.), KNAW, Amsterdam; and Department of Ophthalmology (P.T.V.M.d.J.), Academic Medical Center, Amsterdam, The Netherlands.
Address correspondence and reprint requests to DrV.M. de Jong, The Netherlands Institute for Neurosciences, KNAW, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands; e-mail: p.dejong{at}nin.knaw.nl
Background: Retinal vessels may provide information on cerebral vascular pathology, because they share many features with cerebral vessels. A smaller ratio of the retinal arteriolar-to-venular diameters reportedly predicts the risk of stroke. It is unclear if this is due to arteriolar narrowing or venular dilation.
Objective: To investigate whether smaller arteriolar or larger venular diameters are related to the risk of stroke and cerebral infarction.
Methods: This study was based on the prospective population-based Rotterdam Study and included 5,540 participants of 55 years or over, who had gradable fundus transparencies and were free of stroke at baseline (1990 to 1993). For each participant, retinal arteriolar and venular diameters were measured on digitized images of one eye. Follow-up for first-ever stroke was complete until January 1, 2002.
Results: After a mean follow-up of 8.5 years, 411 participants had a stroke, of whom 259 had cerebral infarction. Larger venular diameters were associated with an increased risk of stroke (hazard ratio [HR] adjusted for age and sex per SD increase: 1.12 [95% CI: 1.02 to 1.24]) and cerebral infarction (HR: 1.15 [95% CI: 1.02 to 1.29]). Smaller arteriolar diameters were neither related to the risk of stroke (HR per SD decrease: 1.02 [95% CI: 0.93 to 1.13]) nor to the risk of cerebral infarction (HR: 1.02 [95% CI: 0.90 to 1.15]). After additional adjustment for other cardiovascular risk factors, the results did not change.
Conclusions: Larger retinal venular diameters are associated with an increased risk of stroke and cerebral infarction. The role of venules in cerebrovascular disease warrants further exploration.
Supported by the Netherlands Organization for Scientific Research (NWO) grant 904-61-155, The Hague. Foundations: Optimix, Amsterdam; Netherlands Organization for Scientific Research (NWO), The Hague; Physico Therapeutic Institute, Rotterdam; Alzheimer Nederland (grant V-2001-015); Blindenpenning, Amsterdam; Sint Laurens Institute, Rotterdam; Bevordering van Volkskracht, Rotterdam; Blindenhulp, The Hague; Rotterdamse Blindenbelangen Association, Rotterdam; OOG, The Hague; kfHein, Utrecht; Ooglijders, Rotterdam; Prins Bernhard Cultuurfonds, Amsterdam; Van Leeuwen Van Lignac, Rotterdam; Verhagen, Rotterdam; Netherlands Society for the Prevention of Blindness, Doorn; Van de Mandele, Rotterdam; LSBS, Utrecht; and Elise Mathilde, Maarn. Unrestricted grants were obtained from Topcon Europe BV, Capelle aan de IJssel; Lameris Ootech, Nieuwegein; Carl Zeiss BV Nederland, Sliedrecht; all in The Netherlands, and from Heidelberg Engineering, Dossenheim, Germany.
Disclosure: The authors report no conflicts of interest.
Received July 5, 2005. Accepted in final form January 19, 2006.
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Neurology 2006 66: 1292-1293.
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