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Retinopathy an independent risk factor for heart failure
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Retinopathy is an independent predictor of congestive heart failure, even in people without existing coronary heart disease, diabetes or hypertension, a large, population-based study found.
In an article in the Journal of the American Medical Association, Tien Y. Wong, MD, PhD, and colleagues said their study suggests that microvascular disease such as retinopathy may play a role in the development of heart failure. They suggest that some asymptomatic people who demonstrate retinopathy on ophthalmologic exam may benefit from assessment of their risk for heart failure.
Dr. Wong and colleagues conducted the study using some participants from the Atherosclerosis Risk in Communities Study, a 7-year cohort study in four U.S. communities. All 11,612 participants in the present study, aged 49 to 73 years, had retinal photos taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy, arteriovenous nicking, focal arteriolar narrowing and generalized arteriolar narrowing.
The main outcome measure was an association between retinopathy and incident congestive heart failure (CHF). There were 719 people with retinopathy at baseline, the researchers said.
The cumulative incidence of CHF over the 7-year study was 5.4%, or 492 events. Participants with retinopathy had a higher incidence of CHF (15.1%) than participants without retinopathy (4.8%). After controlling for numerous variables, the presence of retinopathy was associated with a twofold higher risk of CHF. In participants who did not have existing coronary heart disease, diabetes or hypertension, retinopathy was associated with a threefold higher risk of CHF.
“We found a higher relative risk of CHF and a greater population-attributable fraction associated with retinopathy in people with diabetes than in those with hypertension,” the study authors said in the January issue of JAMA. “Among people with diabetes but without pre-existing coronary heart disease and hypertension, the population-attributable fraction for CHF associated with retinopathy was 30.5%, which suggests that nearly a third of heart failure cases in these patients are related to microangiopathic processes as evident by a retinal examination.”