Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the atherosclerosis risk in communities study1☆,
Section snippets
Study design and population
The ARIC Study (sponsored by the National Heart, Lung, and Blood Institute) is an epidemiologic examination of the major factors contributing to the occurrence of cardiovascular disease in middle-aged adults in the United States. It has two main objectives:
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To investigate factors associated with both atherosclerosis and incidence of clinical cardiovascular disease.
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To measure occurrence of coronary heart disease and relate its trends to community levels of risk factors, medical care, and
Methods
Following is a summary of the ARIC Study methods for taking retinal photographs and evaluating them for vascular abnormalities (complete procotols are provided in the ARIC Manual of Operations16).
Photography of participants
Among the 11,114 participants who had photography attempted, photographs were obtained of 1 eye in 99% (Table 1). In these 10,954 subjects with photographs (Table 2), 88% could be measured on the image processor for generalized arteriolar narrowing, 85% could be graded on the light box for focal vascular abnormalities, and 83% could be assessed for both (using the number of subjects in whom photography was tried as the denominator reduced the yield of usable photographs to 81%). Generally, a
Discussion
Using the image processor protocol to measure diameter of the retinal vessels, we found a normal distribution of A/V ratio in the ARIC Study population. Lower A/V ratio, indicating greater degree of generalized arteriolar narrowing, was strongly and monotonically associated with higher blood pressure (for MABP, that was 10 mmHg higher, A/V ratio was 0.02 lower). Using the light box protocol for grading focal arteriolar narrowing, AV nicking, and retinopathy, we found such focal abnormalities in
Acknowledgements
The authors thank Elizabeth Ehrhardt, MD, Robert Sperduto, MD, and the ARIC Retinal Reading Center photography and grading staff (Barbara Esser, Christine Fulmer, Cynthia Hurtenbach, Kelly Kewley, Kathleen Miner, Michael Neider, and Kurt Osterby) for their collaboration in the development of these methods.
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Supported by The National Heart, Lung, and Blood Institute of the National Institutes of Health, Contract Numbers NO1-HC-35125, N01-HC-35126, N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.
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The authors have no proprietary interest in the equipment and techniques described in this article.