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Context: Congestive heart failure (CHF) affects a substantial proportion of ad ults including those without preexisting coronary heart disease. The pathogenesi s of CHF is uncertain, but microvascular disease has been hypothesized as a poss ible factor. Objective: To determine the relationship of retinopathy, a marker o f systemic microvascular disease, to risk of CHF. Design, Setting, and Participa nts: Populationbased, prospective 7-year cohort study in 4 US communities usi ng the Atherosclerosis Risk in Communities Study database. Participants (n=1 161 2, aged 49 to 73 years) had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence o f retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriov enous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. Main Outcome Measures: Association between retinopathy and incident CHF, identi fied from hospitalization and death records. Results: The 7-year cumulative inc idence of CHF was 5.4%(492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1 %vs 4.8%, P< .0 01). After controlling for age, sex, race, preexisting coronary heart disease, m ean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking , body mass index, and study site, the presence of retinopathy was associated wi th a 2-fold higher risk of CHF (relative risk, 1.96; 95%confidence interval, 1 .51-2.54). Among participants without preexisting coronary heart disease, diabe tes, or hypertension, retinopathy was associated with a 3-fold higher risk of C HF (relative risk, 2.98; 95%confidence interval, 1.50-5.92). Conclusions: Reti nopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascu lar disease may play an important role in the development of heart failure in th e general population. Some asymptomatic persons with retinopathy on an ophthalmo logic examination may benefit from further assessment of CHF risk.
Context: Congestive heart failure (CHF) affects a substantial proportion of ad ults including those without preexisting coronary heart disease. The pathogenesi of CHF is uncertain, but microvascular disease has been hypothesized as a poss ible factor. Objective: To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF. Design, Setting, and Participation: Population-based, prospective 7-year cohort study in 4 US communities usi ng the Atherosclerosis Risk in Communities Study database. Participants (n = 1 161 2, aged 49 to 73 years) had retinal photographs between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (eg, microaneurysms, retinal hemorrhages, soft exudates), arteriov enous nicking, focal arteriolar narrowing, and generalized arteriolar narrowing. Main Outcome Measures: Association between retinopathy and incident CHF, identi fied from hospitalization and de Ath records. Results: The 7-year cumulative inc idence of CHF was 5.4% (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1% vs 4.8%, P <.01 01). After controlling for age, sex, race, preexisting coronary heart disease, m ean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and study site, the presence of retinopathy was associated wi th a 2-fold higher risk of CHF (relative risk, 1.96; 95% confidence interval, 1 .51-2.54). Among participants without preexisting coronary heart disease, diabe tes, or hypertension, retinopathy was associated with a 3-fold higher risk of C HF relative risk, 2.98; 95% confidence interval, 1.50-5.92). Conclusions: Reti nopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes, or hypertension. This suggests that microvascu lar disease may play an important role in the development of heart failu rein th e general population. Some asymptomatic persons with retinopathy on an ophthalmo logic examination may benefit from further assessment of CHF risk.