Retinal microvascular abnormalities and risk of lacunar stroke

Atherosclerosis risk in communities study

Hiroshi Yatsuya, Aaron R. Folsom, Tien Y. Wong, Ronald Klein, Barbara E.K. Klein, A. Richey Sharrett

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background and purpose: The retinal microvasculature reflects cumulative small-vessel damage from hypertension and other vascular processes. No study has prospectively examined retinal findings in relation to the incidence of clinical lacunar stroke in comparison with other ischemic stroke subtypes. Methods: In 10 496 adults initially free of stroke, we related retinal findings imaged during 1993 to 1995 with the incidence of hospitalized ischemic strokes through 2005. Results: During a median of 11.2 years of follow-up, 338 incident ischemic strokes occurred (66 lacunar, 192 nonlacunar thrombotic, and 80 cardioembolic). Generalized arteriolar narrowing as measured by the central retinal arteriole equivalent was associated with an increased incidence of lacunar stroke (multivariate-adjusted hazard ratio [HR] per 1-SD decrement of central retinal arteriole equivalent=1.67; 95% CI, 1.23-2.26) but was not associated with other ischemic stroke subtypes. Generalized venular widening as measured by the central retinal venule equivalent was also positively associated with only lacunar stroke (multivariate-adjusted HR per 1-SD increment=1.44; 95% CI, 1.09-1.91). Retinal microvascular abnormalities were positively associated with lacunar stroke incidence (HR for focal arteriolar narrowing=2.22; 95% CI, 1.11=4.48; for arteriovenous nicking, HR=2.38; 95% CI, 1.20-4.71), whereas retinopathy signs (microaneurysms, retinal hemorrhages, and others) were positively associated with nonlacunar thrombotic (HR=2.41; 95% CI, 1.47-3.95) and cardioembolic (HR=2.25; 95% CI, 1.09-4.65) stroke incidence. Conclusions: A narrower central retinal arteriole equivalent, wider central retinal venule equivalent, focal arteriolar narrowing, and arteriovenous nicking were predictive of lacunar stroke. Retinal imaging is useful in understanding the pathophysiology and mechanisms of cerebral small-vessel disease.

Original languageEnglish
Pages (from-to)1349-1355
Number of pages7
JournalStroke
Volume41
Issue number7
DOIs
Publication statusPublished - 01-07-2010
Externally publishedYes

Fingerprint

Lacunar Stroke
Atherosclerosis
Stroke
Arterioles
Incidence
Venules
Cerebral Small Vessel Diseases
Retinal Hemorrhage
Microvessels
Blood Vessels
Hypertension

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Yatsuya, Hiroshi ; Folsom, Aaron R. ; Wong, Tien Y. ; Klein, Ronald ; Klein, Barbara E.K. ; Sharrett, A. Richey. / Retinal microvascular abnormalities and risk of lacunar stroke : Atherosclerosis risk in communities study. In: Stroke. 2010 ; Vol. 41, No. 7. pp. 1349-1355.
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abstract = "Background and purpose: The retinal microvasculature reflects cumulative small-vessel damage from hypertension and other vascular processes. No study has prospectively examined retinal findings in relation to the incidence of clinical lacunar stroke in comparison with other ischemic stroke subtypes. Methods: In 10 496 adults initially free of stroke, we related retinal findings imaged during 1993 to 1995 with the incidence of hospitalized ischemic strokes through 2005. Results: During a median of 11.2 years of follow-up, 338 incident ischemic strokes occurred (66 lacunar, 192 nonlacunar thrombotic, and 80 cardioembolic). Generalized arteriolar narrowing as measured by the central retinal arteriole equivalent was associated with an increased incidence of lacunar stroke (multivariate-adjusted hazard ratio [HR] per 1-SD decrement of central retinal arteriole equivalent=1.67; 95{\%} CI, 1.23-2.26) but was not associated with other ischemic stroke subtypes. Generalized venular widening as measured by the central retinal venule equivalent was also positively associated with only lacunar stroke (multivariate-adjusted HR per 1-SD increment=1.44; 95{\%} CI, 1.09-1.91). Retinal microvascular abnormalities were positively associated with lacunar stroke incidence (HR for focal arteriolar narrowing=2.22; 95{\%} CI, 1.11=4.48; for arteriovenous nicking, HR=2.38; 95{\%} CI, 1.20-4.71), whereas retinopathy signs (microaneurysms, retinal hemorrhages, and others) were positively associated with nonlacunar thrombotic (HR=2.41; 95{\%} CI, 1.47-3.95) and cardioembolic (HR=2.25; 95{\%} CI, 1.09-4.65) stroke incidence. Conclusions: A narrower central retinal arteriole equivalent, wider central retinal venule equivalent, focal arteriolar narrowing, and arteriovenous nicking were predictive of lacunar stroke. Retinal imaging is useful in understanding the pathophysiology and mechanisms of cerebral small-vessel disease.",
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Retinal microvascular abnormalities and risk of lacunar stroke : Atherosclerosis risk in communities study. / Yatsuya, Hiroshi; Folsom, Aaron R.; Wong, Tien Y.; Klein, Ronald; Klein, Barbara E.K.; Sharrett, A. Richey.

In: Stroke, Vol. 41, No. 7, 01.07.2010, p. 1349-1355.

Research output: Contribution to journalArticle

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T1 - Retinal microvascular abnormalities and risk of lacunar stroke

T2 - Atherosclerosis risk in communities study

AU - Yatsuya, Hiroshi

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AU - Klein, Barbara E.K.

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N2 - Background and purpose: The retinal microvasculature reflects cumulative small-vessel damage from hypertension and other vascular processes. No study has prospectively examined retinal findings in relation to the incidence of clinical lacunar stroke in comparison with other ischemic stroke subtypes. Methods: In 10 496 adults initially free of stroke, we related retinal findings imaged during 1993 to 1995 with the incidence of hospitalized ischemic strokes through 2005. Results: During a median of 11.2 years of follow-up, 338 incident ischemic strokes occurred (66 lacunar, 192 nonlacunar thrombotic, and 80 cardioembolic). Generalized arteriolar narrowing as measured by the central retinal arteriole equivalent was associated with an increased incidence of lacunar stroke (multivariate-adjusted hazard ratio [HR] per 1-SD decrement of central retinal arteriole equivalent=1.67; 95% CI, 1.23-2.26) but was not associated with other ischemic stroke subtypes. Generalized venular widening as measured by the central retinal venule equivalent was also positively associated with only lacunar stroke (multivariate-adjusted HR per 1-SD increment=1.44; 95% CI, 1.09-1.91). Retinal microvascular abnormalities were positively associated with lacunar stroke incidence (HR for focal arteriolar narrowing=2.22; 95% CI, 1.11=4.48; for arteriovenous nicking, HR=2.38; 95% CI, 1.20-4.71), whereas retinopathy signs (microaneurysms, retinal hemorrhages, and others) were positively associated with nonlacunar thrombotic (HR=2.41; 95% CI, 1.47-3.95) and cardioembolic (HR=2.25; 95% CI, 1.09-4.65) stroke incidence. Conclusions: A narrower central retinal arteriole equivalent, wider central retinal venule equivalent, focal arteriolar narrowing, and arteriovenous nicking were predictive of lacunar stroke. Retinal imaging is useful in understanding the pathophysiology and mechanisms of cerebral small-vessel disease.

AB - Background and purpose: The retinal microvasculature reflects cumulative small-vessel damage from hypertension and other vascular processes. No study has prospectively examined retinal findings in relation to the incidence of clinical lacunar stroke in comparison with other ischemic stroke subtypes. Methods: In 10 496 adults initially free of stroke, we related retinal findings imaged during 1993 to 1995 with the incidence of hospitalized ischemic strokes through 2005. Results: During a median of 11.2 years of follow-up, 338 incident ischemic strokes occurred (66 lacunar, 192 nonlacunar thrombotic, and 80 cardioembolic). Generalized arteriolar narrowing as measured by the central retinal arteriole equivalent was associated with an increased incidence of lacunar stroke (multivariate-adjusted hazard ratio [HR] per 1-SD decrement of central retinal arteriole equivalent=1.67; 95% CI, 1.23-2.26) but was not associated with other ischemic stroke subtypes. Generalized venular widening as measured by the central retinal venule equivalent was also positively associated with only lacunar stroke (multivariate-adjusted HR per 1-SD increment=1.44; 95% CI, 1.09-1.91). Retinal microvascular abnormalities were positively associated with lacunar stroke incidence (HR for focal arteriolar narrowing=2.22; 95% CI, 1.11=4.48; for arteriovenous nicking, HR=2.38; 95% CI, 1.20-4.71), whereas retinopathy signs (microaneurysms, retinal hemorrhages, and others) were positively associated with nonlacunar thrombotic (HR=2.41; 95% CI, 1.47-3.95) and cardioembolic (HR=2.25; 95% CI, 1.09-4.65) stroke incidence. Conclusions: A narrower central retinal arteriole equivalent, wider central retinal venule equivalent, focal arteriolar narrowing, and arteriovenous nicking were predictive of lacunar stroke. Retinal imaging is useful in understanding the pathophysiology and mechanisms of cerebral small-vessel disease.

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