Are retinal arteriolar abnormalities related to atherosclerosis? The atherosclerosis risk in communities study

The objective of this study was to describe associations of retinal arterio lar abnormalities with clinical and subclinical manifestations of atheroscl erosis and a broad group of risk factors for vascular disease. A biracial p opulation of 8772 adults (aged 48 to 72 years) living in 4 communities was examined from 1993 to 1995 were studied for that purpose. Retinal arteriove nous nicking and focal arteriolar narrowing were determined by light-box gr ading of a 45 degrees fundus photograph by use of a standardized protocol. Diameters of arterioles and venules were measured in digitized photographs, and a summary arteriolar-to-venular ratio was derived as an index of gener alized arteriolar narrowing, Focal arteriolar narrowing was associated only with hypertension, Generalized arteriolar narrowing was associated with ca rotid plaque but not with any other evidence of atherosclerosis, either cli nical (cardiovascular disease or stroke) or subclinical (carotid or poplite al artery thickness or lower limb obstructive disease), or with plasma chol esterol. It was also associated with smoking, with inflammatory markers (wh ite blood cell count, fibrinogen, and reduced albumin), and with the trigly ceride and high density lipoprotein cholesterol changes associated with inf lammation. Arteriovenous nicking was inconsistently associated with subclin ical atherosclerosis, It was not associated with cardiovascular disease, st roke, or plasma cholesterol. Arteriovenous nicking was associated with mark ers of inflammation and vascular endothelial dysfunction (von Willebrand fa ctor and factor VIII), Arteriolar narrowing and nicking appear to be relate d to hypertension and inflammatory factors. Nicking may also be related to endothelial dysfunction, Results suggest that these arteriolar changes are pathologically distinct from atherosclerosis. Including their measurement i n population studies may permit evaluation of the independent contribution of arteriolar disease to various ischemic diseases of the heart, brain, and other organs.