This proposal describes an ancillary analytical study based on the Atherosclerosis Risk in Communities (ARIC) study cohort, builds upon new knowledge that suggest that retinal microvascular disease is related to incident coronary heart disease in women, and incident stroke in men and women, independent of established cardiovascular risk factors. The present proposed study is now aimed at describing the relation of retinal microvascular disease (retinal arteriolar narrowing, arterio-venous nicking, and retinopathy) to incident hypertension, incident diabetes, and other age-related vascular disorders (cognitive decline, renal dysfunction, and cerebral white matter lesions). The study population is derived from the 15,792 participants of the ARIC study, a well-characterized bi-racial cohort of men and women 45-64 years of age, who were first examined in 1987-89 (baseline) and every three years thereafter for a total of four visits. During the course of the four visits and the continuing annual follow-up surveillance, hypertension and diabetes were evaluated by a standardized history questionnaire, physical examination, and laboratory tests; cognitive function was evaluated by neuropsychological tests; renal function was evaluated by serum creatinine measurement; and cerebral white matter lesions and atrophy were evaluated by cerebral MRI on a sample of persons. The study will comprise a series of new analyses to evaluate in detail the association of retinal microvascular abnormalities to these disorders. This will include both longitudinal (relation of retinal abnormalities to incident hypertension and incident diabetes) and cross-sectional (relation of retinal abnormalities to cognitive impairment, renal dysfunction, and cerebral white matter lesions and atrophy) analyses. It is anticipated that for each of these, individual data sets will have to be constructed, variables defined, and separate analyses performed. The work proposed goes beyond the original analyses relating retinal findings to coronary heart disease and stroke. This grant will provide necessary funds specific to the proposed analyses, capitalizing on the extensive ARIC study data already collected over more than ten years, and unavailable elsewhere. This study will improve the understanding of the relation of the microvascular diseases to the development hypertension, diabetes, and other age-related vascular conditions, in representative populations of men and women.
