A new study suggests that the health of the retinal microvasculature could serve as an indicator for subclinical coronary atherosclerosis in asymptomatic individuals with elevated cardiovascular risk. The findings, published in JAMA Cardiology, show a significant association between reduced retinal vascular density, measured by optical coherence tomography angiography (OCTA), and the presence and severity of coronary artery disease (CAD) detected by coronary computed tomography angiography (CTA).¹

This single-centre, cross-sectional cohort study was conducted at the Asan Medical Center in Seoul, South Korea. Researchers analysed data from 1,286 asymptomatic participants (mean age 64.2 years; 37.5% female) with elevated cardiovascular risk who underwent both coronary CTA and retinal OCTA between October 2015 and December 2020.

OCTA, a non-invasive imaging technique, was used to quantify retinal microvascular parameters, primarily the parafoveal vascular density (PFVD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). These were correlated with coronary CTA findings, including coronary artery calcium score (CACS), plaque burden, segment stenosis score (SSS), segment involvement score (SIS), and the presence of obstructive or severe CAD. The primary outcome was the association between these OCTA and coronary CTA parameters.

The analysis revealed a significant inverse relationship between retinal PFVD and the burden of subclinical coronary atherosclerosis. As PFVD decreased, measures of atherosclerosis such as CACS, plaque presence, SSS, and SIS significantly increased.

Participants in the lowest quartile of SCP PFVD had significantly higher odds of having obstructive CAD (adjusted odds ratio [aOR], 2.91; 95% CI, 1.83–4.73) and severe CAD (aOR, 3.30; 95% CI, 1.55–7.91) compared to those in the highest quartile. Similar, though less pronounced, associations were found for DCP PFVD.

Furthermore, incorporating PFVD into models with traditional cardiovascular risk factors improved the diagnostic performance for identifying severe CAD (Area Under the Curve [AUC], 0.79), obstructive CAD (AUC, 0.78), and an SSS of 10 or higher (AUC, 0.77). SCP PFVD demonstrated superior performance over DCP PFVD as a diagnostic marker.

These findings support the concept of using the eye as a window to systemic vascular health. The study authors concluded that “reduced retinal PFVD was independently associated with subclinical coronary atherosclerosis in a population with elevated vascular risk.” They added that in this context, “decreased PFVD may reflect greater subclinical coronary atherosclerotic burden and help identify individuals who could benefit from further coronary evaluation, beyond traditional risk factors.”¹ The non-invasive nature of OCTA could make it a useful complementary screening tool in ophthalmology settings for identifying individuals who may warrant a more comprehensive cardiovascular assessment.²

References

1. Yang JM, Yang DH, Lee S, et al. Subclinical coronary atherosclerosis and retinal optical coherence tomography angiography. JAMA Cardiol. 2025. https://doi.org/10.1001/jamacardio.2025.3036

2. Kang SH, Park GM, Lee SW, et al. Long-term prognostic value of coronary CT angiography in asymptomatic type 2 diabetes mellitus. JACC Cardiovasc Imaging. 2016;9(11):1292–1300. https://doi.org/10.1016/j.jcmg.2016.01.040

This study was funded by the National Research Foundation grant funded by the Korean government and the Global Physician-Scientist program funded by the Ministry of Health and Welfare of Korea.

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