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Author Notes:

Gen-Min Lin; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611. Tel: 312-908-5749; Fax: 312-908-9588. Email: gen-min.lin@northwestern.edu

GML wrote and corresponded to the paper; LAC made the present analyses; BEK, MFC, TYW, CYC, SRH, AA, YK, RAK, and DLJ interpreted the data and made intellectual contributions to the writing of the final version of the manuscript; KL was the senior author. All authors have read and approved the manuscript.

The authors would like to thank the investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

Disclosure: None


Research Funding:

This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute at the National Institutes of Health and by grants UL1-RR-024156 and UL1-RR-025005 from National Center for Research Resources (NCRR). Retinal data were collected under an Intramural Research Award ZIAEY000403 by the National Eye Institute, National Institutes of Health. Identification of atrial fibrillation was supported by R01HL127659 from the National Heart, Lung, and Blood Institute. Additional supports were provided by grant 16EIA26410001 from the American Heart Association (AHA) and by grant 805C-109–07 from the Hualien Armed Forces General Hospital, Taiwan.


  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation
  • Ethnicity
  • Female
  • Humans
  • Incidence
  • Male
  • Microvessels
  • Middle Aged
  • Retinal Diseases
  • Retinal Vessels
  • Retrospective Studies
  • Risk Factors
  • United States

Association of Retinal Microvascular Signs with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

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Journal Title:

Ophthalmology Retina


Volume 5, Number 1


, Pages 78-85

Type of Work:

Article | Post-print: After Peer Review


Purpose: Microvascular diseases may contribute to the occurrence of atrial fibrillation (AF). Retinal microvascular signs that are similar to other microvasculature in the body and can be visualized directly via ophthalmoscopy may provide insights into such a relationship. Design: Prospective, longitudinal, multiethnic study. Participants: We examined the association between retinal microvascular signs and incident AF in 4994 participants 47 to 86 years of age and free of prior AF who underwent fundus photography from 2002 through 2004 and were followed up through 2015 in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: Retinal microvascular signs evaluated include central retinal arteriolar equivalent and central retinal venular equivalent (CRVE) and presence of any retinopathy signs (e.g., retinal microaneurysms or hemorrhages). A multivariate Cox regression analysis was used to determine the relationship while adjusting for traditional risk factors, alcohol intake, body mass index, diabetes status, chronic kidney disease status, hemoglobin A1c level, C-reactive protein level, medications, and prevalent cardiovascular diseases or heart failure. Main Outcome and Measures: Incident AF events were identified using 12-lead electrocardiographic findings, hospital discharge records, and Medicare claims data. Results: During a median follow-up of 14.1 years, 643 AF events were identified. No association was found between any retinal microvascular signs and incident AF except for retinal focal arteriolar narrowing (hazard ratio, 1.75; 95% confidence interval, 1.06–2.87) in the overall population. However, in the subgroup analyses by gender, wider CRVE was associated with a higher risk of incident AF in women, but not in men (hazard ratio for every 10-μm increase in CRVE, 1.08 [95% confidence interval, 1.01–1.15] and 0.97 [95% confidence interval, 0.92–1.03], respectively; P = 0.041 for interaction). Conclusions: No consistent pattern of association was found between retinal microvascular signs and incident AF. We observed an association in women, but not in men, of wider retinal venular calibers with incidence of AF. The reasons for a possible interaction are incompletely understood.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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