[Systemic cardiovascular risk assessment. Conventional or eye fundus-based?].

Area of Science:

• Ophthalmology and Cardiology
• Medical Imaging and Diagnostics

Context:

• Established cardiovascular (CV) risk algorithms like ESC HeartScore, Framingham, and PROCAM are widely used in Germany.
• These algorithms utilize various risk factors but generate differing risk estimates.
• The homology between retinal and cerebral vasculature suggests potential for ocular examination in CV risk assessment.

Purpose:

• To evaluate the utility of eye fundus examination in enhancing systemic cardiovascular risk prediction.
• To assess the predictive power of retinal vascular changes and retinopathy signs for cardiovascular events.

Summary:

• Retinal vascular changes (e.g., arteriovenous ratio) and retinopathy signs (e.g., cotton-wool spots, microaneurysms) were investigated for their ability to predict systemic CV events.
• While retinopathy signs demonstrated high predictive power, they are infrequently diagnosed.
• Current retinal vascular changes showed minimal enhancement to systemic CV risk prediction.

Impact:

• Suggests that while retinopathy signs are predictive, their rarity limits clinical utility.
• Highlights the need for prospective validation of novel static and dynamic retinal analysis approaches.
• Identifies a promising, yet underexplored, avenue for improving cardiovascular risk stratification through ocular imaging.