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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.<\/jats:p>","DOI":"10.64898\/2026.10.01.26364520","type":"posted-content","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:15:13Z","timestamp":1790982913000},"source":"Crossref","is-referenced-by-count":0,"title":["Retinal vascular trajectories and their associations with systemic health in the Canadian Longitudinal Study on Aging"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5488-5620","authenticated-orcid":false,"given":"Thomas H","family":"Julian","sequence":"first","affiliation":[{"name":"Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"Centre for Computational Imaging and Modelling in Medicine (CIMIM), The Christabel Pankhurst Institute, The University of Manchester, Manchester, UK"},{"name":"Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Moussa","sequence":"additional","affiliation":[{"name":"Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia R","family":"Morgan","sequence":"additional","affiliation":[{"name":"Institute for Neuroscience and Cardiovascular Research, College of Medicine and Veterinary Medicine, University of Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"MacGillivray","sequence":"additional","affiliation":[{"name":"Institute for Neuroscience and Cardiovascular Research, College of Medicine and Veterinary Medicine, University of Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Keavney","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, Manchester Centre of Research Excellence, University of Manchester, Manchester, UK"},{"name":"British Heart Foundation (BHF) Manchester Centre of Research Excellence, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Sperrin","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro F","family":"Frangi","sequence":"additional","affiliation":[{"name":"Centre for Computational Imaging and Modelling in Medicine (CIMIM), The Christabel Pankhurst Institute, The University of Manchester, Manchester, UK"},{"name":"British Heart Foundation (BHF) Manchester Centre of Research Excellence, University of Manchester, Manchester, UK"},{"name":"Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"Department of Computer Science, School of Engineering, Faculty of Science and Engineering, University of Manchester, Manchester, UK"},{"name":"Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis I","family":"Sergouniotis","sequence":"additional","affiliation":[{"name":"Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"Manchester Centre for Genomic Medicine, Saint Mary\u2019s Hospital, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026100703000748000_2026.10.01.26364520v1.1","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1007\/s00415-023-12171-6","article-title":"Retinal imaging for the assessment of stroke risk: a systematic review","volume":"271","year":"2024","journal-title":"J. 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