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

  1. Askiel Bruno, MD;
  2. William L. Jones, OD;
  3. Jeffrey K. Austin, OD;
  4. Shelley Carter, RN; and
  5. Clifford Qualls, PhD
  1. 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.

    Abstract

    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.

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    1. Ann Intern Med February 15, 1995 vol. 122 no. 4 249-253
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