1. Home>
2. Specialties>
3. Cardiology>
4. Summary and Comment

Retinopathy Linked with New Heart Failure

New data support a pathophysiologic link between microvascular disease and development of heart failure.

Microvascular disease (MVD) has been proposed as a cause of ischemic symptoms in people without epicardial coronary artery disease (CAD) and as a cause or contributor to heart failure (HF) associated with diabetes and hypertension. These researchers analyzed data on MVD and new-onset HF from 11,612 healthy participants (age range, 49-73; 56% women; 22% African American) in a prospective, population-based cohort study of atherosclerosis risk factors in four U.S. communities. Retinopathy, assessed by standardized grading of retinal photographs, was used as a marker of MVD.

During a mean follow-up of 6.2 years, HF incidence (defined as hospitalization or death due to HF) was 5.4%. The cumulative 7-year incidence was significantly higher among participants with retinopathy (15%) than among those without it (5%). After adjustment for common potential confounders, the relative risk for new HF associated with retinopathy was 1.96 (95% CI, 1.51-2.54). Among patients without preexisting CAD or hypertension, the RR for new HF associated with retinopathy was 2.98 in patients without diabetes and 4.32 in patients with diabetes.

Comment: In middle-aged people, retinopathy was independently associated with new-onset HF. These findings support a pathophysiologic link between microvascular disease and development of HF -- a link for which the precise mechanism(s) have yet to be clarified. For now, clinicians should screen patients with retinopathy periodically for early signs and symptoms of HF and, when retinopathy is detected, should consider assessing LV function. We don't yet know the value of routine cardiac imaging in asymptomatic patients with retinopathy; recommendations about its use must await further study.

— William T. Abraham, MD

Published in Journal Watch Cardiology March 11, 2005

Citation(s):

Wong TY et al. Retinopathy and risk of congestive heart failure. JAMA 2005 Jan 5; 293:63-9.

• Original article (Subscription may be required)
• Medline abstract (Free)