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Both polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) have been associated with an increased future risk of cardiovascular disease (CVD).1 However, it remains uncertain whether this is a consequence of inflammatory disease or relates to a common underlying mechanism. Retinal vascular images are a sensitive measures of vascular health, which are emerging as important biomarkers of future cardiovascular risk with changes affecting arterioles and venules.2 In this study, we assess whether vasculometric features associated with CVD are detectable prior to the onset of PMR and GCA.
We analysed data from initially healthy subjects enrolled in the EPIC-Norfolk Study, a prospective population-based cohort which enrolled participants between the years 1993 and 1997.3 4 Digital photographs of the retinal fundus were taken of 8112 participants between 2004 and 2011 using a TRC-NW6S non-mydriatic retinal camera and IMAGEnet Telemedicine System (Topcon Corporation, Tokyo, Japan) with a 10 MP Nikon D80 camera (Nikon Corporation, Tokyo, Japan). Retinal vessel widths were measured using the QUARTZ (QUantitative Analysis of Retinal vessel Topology and siZe) programme.5 The fully automated algorithm uses an ensemble classifier of bagged decision trees to allocate vessels into arterioles and venules at 80% probability and calculates summary measures for each participant with an averaged measure between right and left eyes.
Cases of PMR …
Handling editor Josef S Smolen
Contributors MY: study design, data curation, analysis, drafting the manuscript. RoW: computer programmer for the QUARTZ group. AR: data analyst for generating vasculometric measures from QUARTZ derived measures of pixel width. TP: data controller of retinal images. AJM: input to study design and supervision of MY during his doctoral thesis. AK: ophthalomologist with input in to the design and execution of the third health check during which retinal images were taken. RAW: input to study design and secondary supervision of MY during his doctoral thesis. DB: ophthalomologist with input in to the design and execution of the third health check during which retinal images were taken. SH: research associate for EPIC with responsibility for the runing of the third health check. RL: research data manager responsibile for EPIC-Norfolk. SB: PI and lead of QUARTZ group. CO: data analyst for generating vasculometric measures from QUARTZ derived measures of pixel width. K-TK: PI of EPIC-Norfolk and custodian of the data. PF: PI of the third health check for EPIC. All PIs had input into the conception, design and undertaking of the study. All authors commented and edited previous drafts of the manuscript.
Funding EPIC-Norfolk infrastructure and core functions are supported by grants from the Medical Research Council (G1000143) and Cancer Research UK (C864/A14136). The clinic for the third health examination was funded by Research into Ageing (262). The retinal vessel morphometry work was supported by the Medical Research Council Population and Systems Medicine Board (MR/L02005X/1) and British Heart Foundation (PG/15/101/31889). MY was Clinical Research Fellow Versus Arthritis. AK is a Wellcome Trust Clinical Research Fellow. Prof Foster has received additional support from the Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and the UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology. None of the funding organisations had a role in the design or conduct of the research.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Norfolk Local Research Ethics Committee. Participants consented to the study and access to their records was granted. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. The study complies with the Declaration of Helsinki. The Norwich District Health Authority Ethics Committee approved the study and all participants gave written informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data requests and collaborations are reviewed and assessed by the EPIC-Norfolk Management Committee.