Retinal Arteriolar Tortuosity and Cardiovascular Risk Factors in a Multi-Ethnic Population Study of 10-Year-Old Children; the Child Heart and Health Study in England (CHASE)

Objective—To examine the association between cardiovascular risk factors and retinal arteriolar tortuosity in a multi-ethnic child population. Methods and Results—Cross sectional study of 986 UK primary school children of South Asian, black African Caribbean, and white European origin aged 10 to 11 years. Anthropometric measurements and retinal imaging were carried out and a fasting blood sample collected. Digital images of retinal arterioles were analyzed using a validated semiautomated measure of tortuosity. Associations between tortuosity and cardiometabolic risk factors were analyzed using multi-level linear regression, adjusted for gender, age, ethnicity, arteriole branch status, month, and school. Levels of arteriolar tortuosity were similar in boys and girls and in different ethnic groups. Retinal arteriolar tortuosity was positively associated with levels of triglyceride, total and LDL cholesterol, and systolic and diastolic blood pressure. One standard deviation increases in these risk factors were associated with 3.7% (95% CI: 1.2%, 6.4%), 3.3% (0.9%, 5.8%), 3.1% (0.6%, 5.6%), 2.0% (−0.3%, 4.2%), and 2.3% (0.1%, 4.6%) increases in tortuosity, respectively. Adiposity, insulin resistance, and blood glucose showed no associations with tortuosity. Conclusion—Established cardiovascular risk factors, strongly linked to coronary heart disease in adulthood, may influence retinal arteriolar tortuosity at the end of the first decade of life.

[1]  James C. Beyer,et al.  Coronary Disease Among United States Soldiers Killed in Action in Korea: Preliminary Report , 1953 .

[2]  A statistical investigation of the correlation of retinal arteriolar tortuosity with blood pressure and age. , 1961, Transactions of the Canadian Ophthalmological Society.

[3]  R. Paffenbarger,et al.  Chronic disease in former college students. X. The effects of single and multiple characteristics on risk of fatal coronary heart disease. , 1969, American journal of epidemiology.

[4]  R. Paffenbarger,et al.  Chronic disease in former college students; 13. Early precursors of peptic ulcer. , 1966, American journal of epidemiology.

[5]  E. Michelson,et al.  Retinal arteriolar changes as an indicator of coronary artery disease. , 1979, Archives of internal medicine.

[6]  D. Freedman,et al.  Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study. , 1986, The New England journal of medicine.

[7]  Gerald S. Berenson,et al.  Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis: the Bogalusa heart study , 1986 .

[8]  H. Kemper,et al.  Tracking of health and risk indicators of cardiovascular diseases from teenager to adult: Amsterdam Growth and Health Study. , 1990, Preventive medicine.

[9]  P. Allhoff,et al.  Bogalusa Heart Study , 2020, Encyclopedia of Behavioral Medicine.

[10]  S. Srinivasan,et al.  Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. , 1991, American journal of epidemiology.

[11]  S. Syme,et al.  Longitudinal prediction of adult blood pressure from juvenile blood pressure levels. , 1992, American journal of epidemiology.

[12]  K Y Liang,et al.  Serum cholesterol in young men and subsequent cardiovascular disease. , 1993, The New England journal of medicine.

[13]  S. Daniels,et al.  Determinants of retinal vascular abnormalities in children and adolescents with essential hypertension. , 1993, Journal of human hypertension.

[14]  M. Røder,et al.  Enzyme immunoassay for intact human insulin in serum or plasma. , 1993, Clinical chemistry.

[15]  J. Strong,et al.  Risk Factors for Atherosclerosis in Young Subjects: The PDAY Study , 1997, Annals of the New York Academy of Sciences.

[16]  J. Levy,et al.  Correct Homeostasis Model Assessment (HOMA) Evaluation Uses the Computer Program , 1998, Diabetes Care.

[17]  J F Cornhill,et al.  Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. , 1999, JAMA.

[18]  G. Smith,et al.  Blood pressure in young adulthood and mortality from cardiovascular disease , 2000, The Lancet.

[19]  J. Deanfield,et al.  Cholesterol and arterial distensibility in the first decade of life: a population-based study. , 2000, Circulation.

[20]  P C Hindmarsh,et al.  Performance of a new pubertal self-assessment questionnaire: a preliminary study. , 2001, Paediatric and perinatal epidemiology.

[21]  J S Wolffsohn,et al.  Improving the description of the retinal vasculature and patient history taking for monitoring systemic hypertension , 2001, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[22]  R. Klein,et al.  Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study , 2001, The Lancet.

[23]  J. Stam,et al.  Retinal arterial changes correlate with cerebral small-vessel disease , 2002, Neurology.

[24]  Thomas J. Liesegang,et al.  Retinal arteriolar narrowing and risk of coronary heart disease in men and women: The Atherosclerosis Risk in Communities Study. Wong TY, ∗ Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, Klein BEK, Hubbard LD. JAMA 2002;287:1153–1159. , 2002 .

[25]  R. Klein,et al.  Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. , 2002, JAMA.

[26]  R. Klein,et al.  Relationships between age, blood pressure, and retinal vessel diameters in an older population. , 2003, Investigative ophthalmology & visual science.

[27]  D. Mutti,et al.  Refractive error and ethnicity in children. , 2003, Archives of ophthalmology.

[28]  R. Klein,et al.  Retinal microvascular abnormalities and 10-year cardiovascular mortality: a population-based case-control study. , 2003, Ophthalmology.

[29]  Dr. W. Lotmar,et al.  Measurement of vessel tortuosity on fundus photographs , 1979, Albrecht von Graefes Archiv für klinische und experimentelle Ophthalmologie.

[30]  G. Ottaviani,et al.  Pathogenesis of early atherosclerotic lesions in infants. , 2004, Pathology, research and practice.

[31]  T. Wierzbicki,et al.  The relationship between retinal vessel tortuosity, diameter, and transmural pressure , 2005, Graefe's Archive for Clinical and Experimental Ophthalmology.

[32]  J. J. Wang,et al.  Retinal vascular calibre and the risk of coronary heart disease-related death , 2006, Heart.

[33]  R. Klein,et al.  Abnormalities of Retinal Microvascular Structure and Risk of Mortality From Ischemic Heart Disease and Stroke , 2006, Hypertension.

[34]  R. Klein,et al.  Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study. , 2006, Archives of internal medicine.

[35]  S R Leeder,et al.  heart disease-related death Retinal vascular calibre and the risk of coronary , 2006 .

[36]  R. Klein,et al.  Retinal vascular caliber, cardiovascular risk factors, and inflammation: the multi-ethnic study of atherosclerosis (MESA). , 2006, Investigative ophthalmology & visual science.

[37]  A. Hofman,et al.  Retinal vessel diameters and risk of impaired fasting glucose or diabetes: the Rotterdam study. , 2006, Diabetes.

[38]  Nish Chaturvedi,et al.  Impact of Size at Birth on the Microvasculature: The Avon Longitudinal Study of Parents and Children , 2007, Pediatrics.

[39]  P. Mitchell,et al.  Blood Pressure and Retinal Arteriolar Narrowing in Children , 2007, Hypertension.

[40]  Paul Mitchell,et al.  BMI and Retinal Vascular Caliber in Children , 2007, Obesity.

[41]  S. T. Clay,et al.  Computerized analysis of retinal vessel width and tortuosity in premature infants. , 2008, Investigative ophthalmology & visual science.

[42]  P. Mitchell,et al.  Evidence of Arteriolar Narrowing in Low-Birth-Weight Children , 2008, Circulation.

[43]  M. Larsen,et al.  Straight versus tortuous retinal arteries in relation to blood pressure and genetics , 2008, British Journal of Ophthalmology.

[44]  J. J. Wang,et al.  Ethnic differences in refraction and ocular biometry in a population-based sample of 11–15-year-old Australian children , 2008, Eye.

[45]  U. Ekelund,et al.  Ethnic and gender differences in physical activity levels among 9-10-year-old children of white European, South Asian and African-Caribbean origin: the Child Heart Health Study in England (CHASE Study). , 2009, International journal of epidemiology.

[46]  C. Paterson,et al.  Measuring retinal vessel tortuosity in 10-year-old children: validation of the Computer-Assisted Image Analysis of the Retina (CAIAR) program. , 2009, Investigative ophthalmology & visual science.

[47]  Sarah Barman,et al.  Maximum likelihood estimation of vessel parameters from scale space analysis , 2010, Image Vis. Comput..

[48]  Alicja R. Rudnicka,et al.  Early Emergence of Ethnic Differences in Type 2 Diabetes Precursors in the UK: The Child Heart and Health Study in England (CHASE Study) , 2010, PLoS medicine.

[49]  Peter H Whincup,et al.  Ethnic differences in the prevalence of myopia and ocular biometry in 10- and 11-year-old children: the Child Heart and Health Study in England (CHASE). , 2010, Investigative ophthalmology & visual science.

[50]  K. Bradley,et al.  A New BIA Equation Estimating the Body Composition of Young Children , 2011, Obesity.

[51]  K. Nakashima,et al.  [The Rotterdam study]. , 2011, Nihon rinsho. Japanese journal of clinical medicine.