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. 2024 Jan 2;13(1):2.
doi: 10.1167/tvst.13.1.2.

Retinal Vascular Measurements and Mortality Risk: Evidence From the UK Biobank Study

Mayinuer Yusufu  1   2 , Yutong Chen  3 , Alimu Dayimu  4 , Gabriella Bulloch  2 , Shanshan Jin  5 , Algis J Vingrys  1 , Lei Zhang  1   6 , Xianwen Shang  1   2   7 , Danli Shi  8   9 , Mingguang He  1   2   8   9
Affiliations

Retinal Vascular Measurements and Mortality Risk: Evidence From the UK Biobank Study

Mayinuer Yusufu et al. Transl Vis Sci Technol. .

Abstract

Purpose: This study aimed to investigate the association between quantitative retinal vascular measurements and the risk of all-cause and premature mortality.

Methods: In this population-based cohort study using the UK Biobank data, we employed the Retina-based Microvascular Health Assessment System to assess fundus images for image quality and extracted 392 retinal vascular measurements per fundus image. These measurements encompass six categories of vascular features: caliber, density, length, tortuosity, branching angle, and complexity. Univariate Cox regression models were used to identify potential indicators of mortality risk using data on all-cause and premature mortality from death registries. Multivariate Cox regression models were then used to test these associations while controlling for confounding factors.

Results: The final analysis included 66,415 participants. After adjusting for demographic, health, and lifestyle factors and genetic risk score, 18 and 10 retinal vascular measurements were significantly associated with all-cause mortality and premature mortality, respectively. In the fully adjusted model, the following measurements of different vascular features were significantly associated with all-cause mortality and premature mortality: arterial bifurcation density (branching angle), number of arterial segments (complexity), interquartile range and median absolute deviation of arterial curve angle (tortuosity), mean and median values of mean pixel widths of all arterial segments in each image (caliber), skeleton density of arteries in macular area (density), and minimum venular arc length (length).

Conclusions: The study revealed 18 retinal vascular measurements significantly associated with all-cause mortality and 10 associated with premature mortality. Those identified parameters should be further studied for biological mechanisms connecting them to increased mortality risk.

Translational relevance: This study identifies retinal biomarkers for increased mortality risk and provides novel targets for investigating the underlying biological mechanisms.

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Conflict of interest statement

Disclosure: M. Yusufu, None; Y. Chen, None; A. Dayimu, None; G. Bulloch, None; S. Jin, None; A.J. Vingrys, None; L. Zhang, None; X. Shang, None; D. Shi, None; M. He, None

Figures

Figure 1.
Figure 1.
HRs and FDR-adjusted P values of retinal vascular measurements for all-cause mortality. (A1) FDR-adjusted P values of retinal vascular measurements in the training set. (A2) HRs of retinal vascular measurements in the training set. (B1) FDR-adjusted P values of retinal vascular measurements in the validation set. (B2) HRs of retinal vascular measurements in the validation set. All P values in the figure were FDR adjusted.
Figure 2.
Figure 2.
HRs for the association of retinal parameters with premature and all-cause mortality across all models. Model 1 included retinal vascular measurements only. Model 2 included both retinal vascular measurements and demographic factors, including age, sex, ethnicity, Townsend index (social deprivation), and education. Model 3 used covariates from Model 2 and added health factors, including BMI, self-reported overall health rating, number of treatments/medications taken, and comorbidities (diabetes mellitus, history of cardiovascular diseases, and cancer), as well as lifestyle factors (smoking, alcohol, and physical activity). Model 4 was adjusted for Model 3 plus genetic risk score. *FDR-adjusted P value.
Figure 3.
Figure 3.
HRs and FDR-adjusted P values of retinal vascular measurements for premature mortality. (A1) FDR-adjusted P values of retinal vascular measurements in the training set. (A2) HRs of retinal vascular measurements in the training set. (B1) FDR-adjusted P values of retinal vascular measurements in the validation set. (B2) HRs of retinal vascular measurements in the validation set. All P values in the figure were FDR adjusted.
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