Author + information
- Sunil Kumar Agarwal,
- Nona Sotoodehnia,
- Faye L. Norby,
- Kunihiro Matsushita,
- Lin Chen,
- Barbara Klein,
- Ronald Klein,
- Silvana Lawvere,
- Wayne Rosamond,
- Wong T. Yin,
- Jagat Narula,
- Aaron Folsom,
- Josef Coresh and
- Gerardo Heiss
Background: Microvessel disease has been associated with autonomic dysfunction, abnormal myocardial relaxation, and syndrome X (anginal pain predominantly in women without obstructive CAD). Whether microvascular disease such as retinopathy is associated with sudden cardiac death (SCD) in the general population remains unknown.
Objective: We examined sex specific relationship between retinopathy and risk of SCD.
Methods: In 1993-95, ARIC, a large cohort study from four US communities obtained retinal photographs and graded (microaneurysms, micro-hemorrhages or both) centrally at visit 3 (1993-95). A panel of physicians adjudicated the SCD events through 2012. SCD was defined as a sudden pulseless condition presumed due to a ventricular tachy-arrhythmia occurring out of hospital in a previously stable individual without evidence of a non-cardiac cause of cardiac arrest. Time to event analysis was used to examine association of retinopathy with SCD.
Results: Retinopathy was seen in 7.4% (951/12887) participants at baseline. Over an average follow up of 16.2 years, SCD occurred in 3% (1.9% females and 4.3% males).
The unadjusted rate (95% CI) of SCD per 1000 person years among those with retinopathy was 4.7 (3.7, 6.0) as compared to 1.6 (1.4, 1.8) among those without retinopathy. The unadjusted hazards ratio of SCD comparing those with retinopathy to those without was higher among women 5.00 (3.38, 7.35) than men 2.03 (1.34, 2.98), p for interaction <0.01. After adjustment for age, race, current smoking, body mass index, diabetes status, fasting glucose, hypertension, systolic blood pressure, LDL cholesterol, and prevalent CHD, the hazards ratios were 2.41 (1.56, 3.72) for women vs. 1.18 (0.78, 1.78) for men (p for interaction <0.01).
Conclusions: We found a strong association between retinopathy and SCD among women independent of other risk factors but not among men. If replicated in other cohorts, these results suggest microvascular disease as a putative mechanistic pathway for SCD, and require further exploration.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Updates on Risk Factors for Cardiovascular Disease
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1187-051
- 2017 American College of Cardiology Foundation