microvascular perfusion, impairments in which can cause myocardial ischemia. We examined the association of retinopathy, microalbuminuria and myocardial blood flow, respectively, with lung function and lung density on computed tomography 
in a large, multiethnic cohort free of clinical cardiovascular disease. We hypothesized that these measures of systemic microvascular changes were associated with reduced lung function and lower lung density, and that relationships would be of greater magnitude among smokers. /FVC ratio above the LLN, since the primary hypothesis related to obstructive lung disease. Ethics Statement The protocols of MESA and all studies described herein were approved by the Institutional Review Boards of all collaborating institutions and the National Heart, Lung and Blood Institute. Written informed consent was obtained from all study participants. Microvascular Measures in the Retina, Kidney and Heart Retinal Vascular Caliber. Retinal vascular caliber was measured from digital retinal photographs of both eyes of each participant in 200203. All arterioles and venules coursing through an area one half to one full disc diameter from the optic disc margin were measured using a computer-based program by trained graders masked to participant characteristics at a central reading center. Vascular caliber was summarized as the central retinal artery equivalent and the central retinal vein equivalent, two well-established, reproducible indicators of the average caliber of retinal vessels. Urine Albumin-to-Creatinine Ratio and Albuminuria. Urine albumin and creatinine were measured at the baseline examination by nephelometry and the rate Jaffe reaction. Spot urine albumin -to-creatinine ratios were calculated. Previously published, gender-specific categories of ACR were used to define albuminuria as highnormal urine albumin excretion, microalbuminuria and macroalbuminuria. Myocardial Blood Flow. All participants at one field center were asked to participate in the myocardial perfusion study; 222 agreed and underwent the study, of whom 126 met inclusion Materials and Methods Study sample The Multi-Ethnic Study of Atherosclerosis is a multicenter prospective cohort study of white, African-American, Hispanic and Asian adults. In 20002002, MESA recruited 6,814 men and women ages 45 84 years old from six U.S. communities: Forsyth County, NC; Northern Manhattan and the Bronx, NY; Baltimore City and Baltimore County, MD; St. Paul, MN; Chicago, IL; and Los Angeles, CA. Exclusion criteria included clinical cardiovascular disease, weight greater than 300 lbs, pregnancy and impediment to long-term participation. All measures were ascertained at baseline except as noted below. The MESA Lung Study enrolled 3,965 MESA participants of 4,484 selected who were sampled randomly among those who consented to genetic analyses, underwent baseline measures of endothelial function, and attended an examination during the MESA-Lung recruitment period in 20042006. Asians were oversampled. Similar to prior studies,, we excluded a priori 322 participants with a restrictive pattern of spirometry, defined as a forced vital capacity less than the lower limit of normal , with a forced expiratory R115777 volume in one second Lung Function and Systemic Microvascular Changes criteria for the present report. MBF was measured using gadolinium-enhanced cardiac MRI at rest and again during maximum adenosine-induced vasodilation . All imaging was performed on a 1.5 T magnet w
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