Retinopathy and Risk of Congestive Heart Failure

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Abstract
Congestive heart failure (CHF) is a leading cause of morbidity, hospitalization, and mortality in the United States.1 Despite recent advances in research, the pathogenesis of CHF remains uncertain.2 Microvascular disease has long been suggested as a possible pathogenic factor in the development of different cardiac diseases.3 There is increasing evidence that coronary microvascular dysfunction may be one underlying mechanism in patients with symptoms and signs of myocardial ischemia without angiographically detectable coronary artery disease, and even in asymptomatic patients with cardiovascular risk factors.4,5 Microvascular processes have also been implicated in left ventricular dysfunction and subsequent heart failure,6,7 particularly in people with diabetes8,9 and hypertension,10-12 as well as in patients with dilated13-18 or hypertrophic19 cardiomyopathy. However, the majority of these studies have been cross-sectional and have focused on small samples of highly selected patients. In addition, since the coronary circulation cannot be visualized in vivo, what is known about microvascular mechanisms in the pathogenesis of CHF has been derived indirectly from studies of functional parameters such as myocardial blood flow and coronary flow reserve.20,21 We are unaware of prospective or population-based studies examining whether microvascular disease predicts risk of CHF in the general community.