Vascular outcome in men with asymptomatic retinal cholesterol emboli. A cohort study

Ann Intern Med. 1995 Feb 15;122(4):249-53. doi: 10.7326/0003-4819-122-4-199502150-00002.


Objective: To determine whether asymptomatic retinal cholesterol embolism is a risk factor for vascular events.

Design: Cohort study with retrospectively selected controls.

Setting: A Veterans Affairs medical center.

Patients: 70 consecutive patients with asymptomatic retinal cholesterol emboli on dilated ocular examination in an eye clinic and 70 controls without retinal emboli. Controls were matched to patients for sex; age; prevalence of hypertension, diabetes mellitus, and ischemic heart disease; serum cholesterol level; and smoking history.

Measurements: Stroke, myocardial infarction, and death.

Results: During a mean follow-up of 3.4 years, stroke occurred at an annual rate of 8.5% among patients and 0.8% among controls (adjusted relative risk, 9.9; 95% CI, 2.3 to 43.1; P = 0.002). Nineteen strokes occurred, 17 in patients and 2 in controls; all were nonfatal cerebral infarctions. Twelve of the 17 that occurred in patients were in a carotid artery territory ipsilateral to the qualifying retinal cholesterol embolus and 5 were in another vascular territory. Ocular infarction or hemorrhagic stroke did not occur. Nonfatal myocardial infarction or vascular death occurred at an annual rate of 7.7% among patients and 4.9% among controls (adjusted relative risk, 1.4; 95% CI, 0.7 to 2.9; P = 0.39).

Conclusion: Asymptomatic retinal cholesterol embolism is an important risk factor for cerebral infarction independent of commonly recognized vascular risk factors.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / mortality
  • Cerebral Infarction / etiology*
  • Cerebral Infarction / mortality
  • Embolism, Cholesterol / complications*
  • Follow-Up Studies
  • Humans
  • Male
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Proportional Hazards Models
  • Retinal Diseases / complications*
  • Retrospective Studies
  • Risk Factors