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ARTICLE

Vascular Outcome in Men with Asymptomatic Retinal Cholesterol Emboli: A Cohort Study

Askiel Bruno; William L. Jones; Jeffrey K. Austin; Shelley Carter; and Clifford Qualls

15 February 1995 | Volume 122 Issue 4 | Pages 249-253

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.

Author and Article Information

From the Veterans Affairs Medical Center and the University of New Mexico Medical School, Albuquerque, New Mexico.
Requests for Reprints: Askiel Bruno, MD, Department of Neurology, Indiana University, Emerson Hall 125, 545 Barnhill Drive, Indianapolis, IN 46202-5124.
Acknowledgments: The authors thank Jose Biller, MD, Larry E. Davis, MD, and Edalyn Johnson, RN, MSN, CFNP, for helpful suggestions.
Grant Support: In part by grant MO1 RR00997 from the General Clinical Research Center at the University of New Mexico Medical School.

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