Association of retinal atherosclerosis assessed using Keith-Wagener-Barker system with incident heart failure and other atherosclerotic cardiovascular disease: Analysis of 319,501 individuals from the general population.

Background And Aims: It is not known whether the presence of retinal atherosclerosis (RA) is associated with incident heart failure (HF) in the general population. We aimed to investigate the relationship between RA and the risk of HF development using a nationwide population-based database.

Methods: We studied 319,501 adults without a history of cardiovascular disease (CVD) and with available data on retinoscopy at health check-up registered in the JMDC Claims Database between January 2005 and April 2020. We performed Cox regression analyses to assess the relationship of RA, defined as Keith-Wagener-Barker system grade ≥1, with incident HF and other CVD, including myocardial infarction (MI), angina pectoris (AP), and stroke.

Results: The median age (interquartile range) was 47 (41-54) years, and 159,710 participants (50.0%) were men. RA was observed in 26,168 participants (8.2%). During a median (interquartile range) follow-up of 2.9 (1.6-4.6) years, 6,821 (2.1%) HF, 692 (0.2%) MI, 7,016 (2.2%) AP and 3,584 (1.1%) stroke events occurred. After adjustment for potential confounders, multivariable Cox regression analyses showed that RA was associated with a greater incidence of HF (hazard ratio 1.13, 95% confidence interval [CI] 1.05-1.21) and other CVDs. Hazard ratios of RA for MI, AP, and stroke were 1.17 (95% CI, 0.95-1.44), 1.13 (95% CI, 1.05-1.21), and 1.25 (95% CI, 1.14-1.37), respectively. This association was present in all subgroups.

Conclusions: The assessment of RA may be useful to identify people at high-risk for the development of HF and other atherosclerotic CVD events in a general population.