Prevalence of subclinical retinal ischemia in patients with cardiovascular disease – a hypothesis driven study

Abstract

Background Cardiovascular disease is the leading cause of mortality and disability worldwide. A noninvasive test that can detect underlying cardiovascular disease has the potential to identify patients at risk prior to the occurrence of adverse cardiovascular events. We sought to determine whether an easily observed imaging finding indicative of retinal ischemia, which we term ‘ retinal ischemic perivascular lesions’ (RIPLs), could serve as a biomarker for cardiovascular disease. Methods We reviewed optical coherence tomography (OCT) scans of individuals, with no underlying retinal pathology, obtained at UC San Diego Health from July 2014 to July 2019. We identified 84 patients with documented cardiovascular disease and 76 healthy controls. OCT scans were assessed for evidence of RIPLs. In addition, the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator was used to risk-stratify the subjects into four different categories. Findings Patients with documented cardiovascular disease had higher number of RIPLs compared to healthy controls (2.8 vs 0.8, p < 0.001). After adjusting for age, sex, smoking history, systolic blood pressure and triglycerides, cholesterol and hemoglobin A1C levels, each RIPL was associated with an odds ratio of having cardiovascular disease of 1·60 (1.09–2>37). The number of RIPLs in individuals with intermediate and high 10-year ASCVD risk scores was higher than in those with low ASCVD risk scores (1.7 vs 0.64, p = 0.02 and 2.9 vs 0.64, p 0.002, respectively). Interpretation The presence of RIPLs, which are anatomical markers of prior retinal ischemic infarcts, is suggestive of coexisting cardiovascular disease. RIPLs detection, obtained from routine retinal scans, may thus provide an additional biomarker to identify patients at risk of developing adverse cardiovascular events. Funding None.

Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases

“…In turn, 16.9% of patients with acute ischemic stroke had retinal emboli and 9% had acute retinal artery occlusion [ 52 ]. Patients with a diagnosis of stroke or coronary heart disease had a higher prevalence of asymptomatic retinal ischemia, indicating the coexistence of cardiovascular diseases and retinal stroke [ 53 ].…”

Ehlers-Danlos syndromes and their manifestations in the visual system

“…( 24 ). In addition, these patients are prone to heart failure, which can cause chronic retinal ischemic perivascular lesions identifiable on ocular coherence tomography of the retina ( 25 , 26 ).…”

Cardiovascular Disease Diagnosis from DXA Scan and Retinal Images Using Deep Learning

“…CVDs have accounted for 32% of the overall global death where two-third occurs in low-and middle-income countries, according to the World Health Organization (WHO) [2]. Furthermore, CVD has caused 38% of the total deaths of people below 70 years old of age (i.e., premature deaths) in non-communicable diseases (NCD) [3]. In the East Mediterranean region, 54% of the total NCD deaths are caused by CVD according to the WHO's Eastern Mediterranean Regional Office [4].…”

“…In the State of Qatar, according to the Planning and Statistics Authority, 33.1% of the total deaths in 2018 were caused by diseases related to the circulatory system including blood pressure, which made CVD the top concern for Qatar in combating NCD [5]. Although diagnosis and treatment methods/tools of CVD have advanced throughout the years, yet many people still go undiagnosed until the occurrence of serious CVD events such as stroke, heart attack, or myocardial infraction [3].…”