Relation of retinopathy to coronary artery calcification: The multi-ethnic study of atherosclerosis

Tien Y. Wong, Ning Cheung, F. M.Amirul Islam, Ronald Klein, Michael H. Criqui, Mary Frances Cotch, J. Jeffrey Carr, Barbara E.K. Klein, A. Richey Sharrett

Research output: Contribution to journalArticlepeer-review


Microvascular disease, reflected by retinal vascular changes, has been shown to predict clinical coronary heart disease. Whether retinal vascular changes are associated with subclinical coronary artery disease is unclear and was examined in this study. The authors conducted a multiethnic, population-based study of 6,147 persons aged 45-84 years, sampled from six US communities in 2002-2004, who were free of clinical cardiovascular disease. Coronary artery calcification (CAC), a noninvasive measure of subclinical coronary artery disease, was assessed by cardiac computed tomography scanning and categorized into three groups of increasing severity: none (average CAC score = 0), mild (1-100), and moderate-to-severe (>100). Retinopathy signs and retinal vascular caliber were graded from retinal photographs following standardized protocols. After adjustment for age, gender, race/ethnicity, blood pressure, diabetes, lipid profile, smoking, and other risk factors, retinopathy was associated with having a moderate-to-severe CAC score (odds ratio = 1.43, 95% confidence interval: 1.18, 1.75). This association remained significant in both men and women and in persons with and without diabetes or hypertension. Variations in retinal vascular caliber were not significantly associated with CAC score. This study shows that retinopathy signs are independently associated with CAC, supporting the concept that common pathophysiologic processes may underlie both micro- and macrovascular disease.

Original languageEnglish (US)
Pages (from-to)51-58
Number of pages8
JournalAmerican journal of epidemiology
Issue number1
StatePublished - Jan 2008
Externally publishedYes


  • Arterioles
  • Atherosclerosis
  • Cardiovascular diseases
  • Coronary disease
  • Diabetic retinopathy
  • Microcirculation
  • Retinal vessels
  • Venules

ASJC Scopus subject areas

  • Epidemiology


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