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Australian parent-child concordance values for the microvasculature align with moderate polygenic heritability reported in smaller studies.

In childhood, emerging relationships between microvascular parameters and cardiometabolic risk may be better described by retinal vascular caliber than by geometric parameters.

Adverse retinal microvascular characteristics are associated with hearing loss by midlife, with venular associations possibly emerging by age 11 to 12 years.

Inflammation mediated associations between obesity and retinal venules, but not arterioles from mid-childhood, with higher mediation effects observed in adults.

A high body mass index or a large waist in early childhood impacts on the retinal microvasculature by 11-12 years of age, more via arteriolar than venular mechanisms.

In children and midlife adults, we found that narrower retinal arterioles and wider venules are associated with large arterial function as early as mid-childhood, with associations strengthen by mid-life and also extend to arterial structure.