Retinal emboli and cardiovascular disease - The Beaver Dam Eye Study

Objective: To describe the 10-year incidence of retinal emboli, associated risk factors, and relationship of retinal emboli at baseline to stroke and ischemic heart disease mortality. Methods: The Beaver Dam Eye Study is a large (N = 4926) population-based study of persons 43 to 86 years of age at the time of the baseline examination. Retinal emboli were detected at baseline (1988-1990) and at a 5-year (1993-1995) and 10-year (1998-2000) follow-up by grading of stereoscopic 30degrees color fundus photographs using standardized protocols. Cause-specific mortality was determined from death certificates. Results: The 10-year cumulative incidence of retinal emboli was 1.5%. After adjustment for age and sex, the incidence of retinal emboli was associated with increased pulse pressure (odds ratio [OR] [fourth vs first quartile range], 2.42; 95% confidence interval [CI], 0.98-5.97; P=.03, for test of trend), higher serum total cholesterol level (OR, 2.77; 95% Cl, 1.06-7.23; P=.03), higher white blood cell count (OR, 2.28; 95% Cl, 1.04-4.96; P=.05), smoking status (OR [current vs never-smoker], 4.60; 95% Cl, 2.08-10.16; P<.001), and a history of coronary artery bypass surgery (OR, 7.17; 95% Cl, 3.18-16.18; P<.001) at baseline. After controlling for age, sex, and systemic factors, a significantly higher hazard of dying with a mention of stroke on the death certificate was found in people with retinal emboli (hazard ratio, 2.40; 95% Cl, 1.16-4.99) compared with those without. Conclusions: We found associations of smoking and cardiovascular disease with the incidence of retinal emboli. Persons with retinal emboli are also at increased risk of stroke-related death.