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Vital Exhaustion and Retinal Microvascular Changes in Cardiovascular Disease: Atherosclerosis Risk in Communities Study

From the Centre for Eye Research Australia (N.C., S.R., T.Y.W.), University of Melbourne, VIC, Australia; Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson, Mississippi; Department of Ophthalmology (R.K.), University of Wisconsin, Madison, Wisconsin; Department of Biostatistics (D.C.), University of North Carolina, Chapel Hill, North Carolina; and Singapore Eye Research Institute (T.Y.W.), National University of Singapore, Singapore.

Address correspondence and reprint requests to Tien Yin Wong, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia. E-mail: twong{at}unimelb.edu.au

Objective: To determine if vital exhaustion, a measure of negative emotion, is associated with microvascular changes in the retina. Negative psychological factors, such as depression, have been implicated in the development of cardiovascular disease. Whether this link is mediated by macrovascular or microvascular disease is unknown.

Methods: We performed a population-based, cross-sectional study of 10,364 White and African Americans aged 48 to 73 years. Vital exhaustion scores were determined from the Maastricht questionnaire and categorized into quartiles. Retinopathy signs and retinal vascular caliber were graded from retinal photographs following standardized protocols.

Results: After adjusting for age, gender, race, study center, education, smoking, blood pressure, diabetes, and other risk factors, higher vital exhaustion scores (highest versus lowest quartiles) were associated modestly with the presence of retinopathy (odds ratio [OR] = 1.27; 95% Confidence Interval [CI] = 1.01–1.59), particularly retinal hemorrhages (OR = 1.71; 95% CI = 1.20–2.44), and with generalized retinal venular widening (OR = 1.19; 95% CI = 1.03–1.38). Analyzing vital exhaustion as a continuous variable did not change the pattern of the associations.

Conclusions: Middle-aged people with vital exhaustion may be more likely to have retinopathy signs that have been identified as risk predictors of cardiovascular events. Further research is needed to explore the possible adverse effects of negative emotion on the microcirculation.

Key Words: vital exhaustion • depression • microvascular disease • cardiovascular disease • retinopathy • retinal vascular caliber