Association of the apolipoproteins with retinal arteriosclerosis in a health examination population.

Background: Retinal arteriosclerosis is a non-invasive indicator for systemic microvascular damage and early atherosclerosis. While traditional lipid measures are used to establish cardiovascular risk predictors, Apolipoprotein B (ApoB), Apolipoprotein A1 (ApoA1), and their ratio might provide more insights into the atherogenic burden. However, their association with retinal arteriosclerosis in general health populations has not yet been explored. Methods: This cross-sectional study included 4,938 adults from a health examination cohort. Retinal arteriosclerosis was evaluated by employing fundus photography and the SCHEIE classification. Multivariable logistic regression and restricted cubic spline analyses were used to evaluate the associations between apolipoproteins (ApoA1, ApoB/ApoA1 ratio) and retinal arteriosclerosis, accounting for demographic, lifestyle, clinical, and laboratory confounders. Results: In males, retinal arteriosclerosis prevalence was 13.98%, which is higher than females, who have 8.57%. People with retinal arteriosclerosis showed significantly higher ApoB levels and ApoB/ApoA1 ratios. In fully adjusted models, both ApoB (per 1-SD increase: OR 1.12, 95% CI 1.01-1.24) and ApoB/ApoA1 ratio (per 1-SD increase: OR 1.14, 95% CI 1.03-1.27) remained independently associated with retinal arteriosclerosis. Subgroup analyses revealed significant associations in adults ≥45 years, non-smokers, and non-hypertensive individuals. Conclusion: The ApoB/ApoA1 ratio is independently linked to retinal arteriosclerosis, especially in older adults. These findings indicate that integrating apolipoprotein profiling into cardiovascular risk assessment could improve the early detection of microvascular damage by leveraging the "eye-heart" axis.