Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study

Arch Ophthalmol. 2003 Oct;121(10):1446-51. doi: 10.1001/archopht.121.10.1446.


Objective: To describe the 10-year incidence of retinal emboli, associated risk factors, and relationship of retinal emboli at baseline to stroke and ischemic heart disease mortality.

Methods: The Beaver Dam Eye Study is a large (N = 4926) population-based study of persons 43 to 86 years of age at the time of the baseline examination. Retinal emboli were detected at baseline (1988-1990) and at a 5-year (1993-1995) and 10-year (1998-2000) follow-up by grading of stereoscopic 30 degrees color fundus photographs using standardized protocols. Cause-specific mortality was determined from death certificates.

Results: The 10-year cumulative incidence of retinal emboli was 1.5%. After adjustment for age and sex, the incidence of retinal emboli was associated with increased pulse pressure (odds ratio [OR] [fourth vs first quartile range], 2.42; 95% confidence interval [CI], 0.98-5.97; P =.03, for test of trend), higher serum total cholesterol level (OR, 2.77; 95% CI, 1.06-7.23; P =.03), higher white blood cell count (OR, 2.28; 95% CI, 1.04-4.96; P =.05), smoking status (OR [current vs never-smoker], 4.60; 95% CI, 2.08-10.16; P<.001), and a history of coronary artery bypass surgery (OR, 7.17; 95% CI, 3.18-16.18; P<.001) at baseline. After controlling for age, sex, and systemic factors, a significantly higher hazard of dying with a mention of stroke on the death certificate was found in people with retinal emboli (hazard ratio, 2.40; 95% CI, 1.16-4.99) compared with those without.

Conclusions: We found associations of smoking and cardiovascular disease with the incidence of retinal emboli. Persons with retinal emboli are also at increased risk of stroke-related death.

Publication types

  • Duplicate Publication
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Embolism / complications
  • Embolism / epidemiology*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Ischemia / etiology
  • Myocardial Ischemia / mortality*
  • Odds Ratio
  • Retinal Artery Occlusion / complications
  • Retinal Artery Occlusion / epidemiology*
  • Risk Factors
  • Smoking / adverse effects
  • Stroke / etiology
  • Stroke / mortality*
  • Wisconsin / epidemiology