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

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

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


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% Cl, 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% Cl, 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.

Original languageEnglish (US)
Pages (from-to)249-253
Number of pages5
JournalAnnals of internal medicine
Issue number4
StatePublished - Feb 15 1995
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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