Retinal vascular trajectories and their associations with systemic health in the Canadian Longitudinal Study on Aging
- 1Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
Abstract
Retinal vascular features are proposed biomarkers of systemic health, yet their longitudinal behaviour and relationship to systemic health remain poorly understood. We quantified retinal vascular morphology from serial colour fundus photographs in the Canadian Longitudinal Study on Aging, including 21,562 participants at baseline with good quality images. On average, vascular complexity and density decreased between baseline visit and follow-up 2 (mean interval 5.7 years), whereas tortuosity, arteriolar widths, and venular widths increased. Baseline vascular features were associated with demographic, cardiovascular, metabolic and behavioural traits, whereas altered longitudinal trajectories were associated principally with older age and higher low-density lipoprotein cholesterol. Within-person increases in mean arterial pressure covaried with lower vascular complexity, density and vessel widths. In survival analyses, independently of baseline vascular features, increases in fractal dimension were associated with lower hazard of subsequent all-cause mortality (hazard ratio = 0.92 per standard deviation, 95% confidence interval (CI) = 0.86 - 0.98), whereas arteriolar widening was associated with higher mortality (hazard ratio = 1.09, 95% CI = 1.02 - 1.17). No retinal change metric was associated with major adverse cardiovascular events after false-discovery-rate correction. These findings identify retinal vascular remodelling as a dynamic phenotype associated with systemic health and subsequent mortality, and motivate evaluation of multi-time-point retinal imaging in oculomics.
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BibTeX
@misc{julian2026retinal,
title = {{Retinal vascular trajectories and their associations with systemic health in the Canadian Longitudinal Study on Aging}},
author = {T. H. Julian and G. Moussa and G. R. Morgan and T. MacGillivray and Y. Zhao and B. Keavney and M. Sperrin and A. F. Frangi and P. I. Sergouniotis},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.01.26364520},
url = {https://www.medrxiv.org/content/10.64898/2026.10.01.26364520v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Retinal vascular trajectories and their associations with systemic health in the Canadian Longitudinal Study on Aging
AU - T. H. Julian
AU - G. Moussa
AU - G. R. Morgan
AU - T. MacGillivray
AU - Y. Zhao
AU - B. Keavney
AU - M. Sperrin
AU - A. F. Frangi
AU - P. I. Sergouniotis
PY - 2026
DA - 2026/10/01
PB - medRxiv
DO - 10.64898/2026.10.01.26364520
UR - https://www.medrxiv.org/content/10.64898/2026.10.01.26364520v1
AB - Retinal vascular features are proposed biomarkers of systemic health, yet their longitudinal behaviour and relationship to systemic health remain poorly understood. We quantified retinal vascular morphology from serial colour fundus photographs in the Canadian Longitudinal Study on Aging, including 21,562 participants at baseline with good quality images. On average, vascular complexity and density decreased between baseline visit and follow-up 2 (mean interval 5.7 years), whereas tortuosity, arteriolar widths, and venular widths increased. Baseline vascular features were associated with demographic, cardiovascular, metabolic and behavioural traits, whereas altered longitudinal trajectories were associated principally with older age and higher low-density lipoprotein cholesterol. Within-person increases in mean arterial pressure covaried with lower vascular complexity, density and vessel widths. In survival analyses, independently of baseline vascular features, increases in fractal dimension were associated with lower hazard of subsequent all-cause mortality (hazard ratio = 0.92 per standard deviation, 95% confidence interval (CI) = 0.86 - 0.98), whereas arteriolar widening was associated with higher mortality (hazard ratio = 1.09, 95% CI = 1.02 - 1.17). No retinal change metric was associated with major adverse cardiovascular events after false-discovery-rate correction. These findings identify retinal vascular remodelling as a dynamic phenotype associated with systemic health and subsequent mortality, and motivate evaluation of multi-time-point retinal imaging in oculomics.
ER -