Retinal Arteriolar Narrowing and Risk of Coronary Heart Disease in Men and Women

OF microvascular and macrovascular processes to the risk of coronary heart disease (CHD) is unknown, but its elucidation is important from etiological, preventive, and therapeutic perspectives. 1,2Coronary microvascular disease may explain the occurrence of myocardial ischemia without overt coronary artery blockage, [3][4][5][6][7] as well as risk of heart failure 8,9 and mortality 9 after myocardial infarction (MI).Because women with chest pain are more likely to have normal coronary arteries, 1-4,7 have higher mortality rates after an MI, 10,11 and have poorer outcomes after coronary artery bypass graft surgery, 12 it has been hypothesized that microvascular disease may play a more prominent role in the development of myocardial ischemia and definite CHD in women. 13,14However, most studies of microvascular dysfunction have been conducted in small numbers of highly selected symptomatic patients, [3][4][5][6][7]9 few have been prospective, 9 and none have been population based.][2][3][4][5][6][7] The retinal arterioles offer an opportunity to noninvasively explore the relation of systemic microvascular disease to CHD. 15 These arterioles narrow, and their media thicken and show sclerotic changes, in response to hypertension and other processes.16 In the population-based Atherosclerosis Risk in Communities (ARIC) study, we developed a computer-assisted, digital