VASCULAR OUTCOME IN MEN WITH ASYMPTOMATIC RETINAL CHOLESTEROL EMBOLI - A COHORT STUDY

Objective: To determine whether asymptomatic retinal cholesterol embol ism is a risk factor for vascular events. Design: Cohort study with re trospectively selected controls. Setting: A Veterans Affairs medical c enter. Patients: 70 consecutive patients with asymptomatic retinal cho lesterol emboli on dilated ocular examination in an eye clinic and 70 controls without retinal emboli. Controls were matched to patients for sex; age; prevalence of hypertension, diabetes mellitus, and ischemic heart disease; serum cholesterol level; and smoking history. Measurem ents: Stroke, myocardial infarction, and death. Results: During a mean follow-up of 3.4 years, stroke occurred at an annual rate of 8.5% amo ng patients and 0.8% among controls (adjusted relative risk, 9.9; 95% Cl, 2.3 to 43.1; P = 0.002). Nineteen strokes occurred, 17 in patients and 2 in controls; all were nonfatal cerebral infarctions. Twelve of the 17 that occurred in patients were in a carotid artery territory ip silateral to the qualifying retinal cholesterol embolus and 5 were in another vascular territory. Ocular infarction or hemorrhagic stroke di d not occur. Nonfatal myocardial infarction or vascular death occurred at an annual rate of 7.7% among patients and 4.9% among controls (adj usted relative risk, 1.4; 95% Cl, 0.7 to 2.9; P = 0.39). Conclusion: A symptomatic retinal cholesterol embolism is an important risk factor f or cerebral infarction independent of commonly recognized vascular ris k factors.