Prevalence of subclinical retinal ischemia in patients with cardiovascular disease - a hypothesis driven study
Christopher P Long1, Alison X Chan1, Christine Y Bakhoum2
1School of medicine, University of California San Diego, La Jolla, CA USA.
Insights
Retinal ischemic perivascular lesions (RIPLs) detected on routine eye scans may indicate underlying cardiovascular disease. This finding could help identify at-risk patients for early intervention and prevention of adverse cardiovascular events.
Area of Science:
- Ophthalmology
- Cardiology
- Biomarkers
Background:
- Cardiovascular disease (CVD) is a leading global cause of mortality and disability.
- Early identification of at-risk individuals is crucial for preventing adverse cardiovascular events.
- A noninvasive biomarker for CVD could significantly improve patient outcomes.
Purpose of the Study:
- To investigate whether retinal ischemic perivascular lesions (RIPLs) can serve as a biomarker for cardiovascular disease.
- To assess the association between RIPLs and diagnosed cardiovascular disease.
- To evaluate RIPLs as a potential indicator for cardiovascular risk stratification.
Main Methods:
- Retrospective review of optical coherence tomography (OCT) scans from patients with and without cardiovascular disease.
- Identification and quantification of RIPLs in individuals with no underlying retinal pathology.
- Utilized the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator for risk stratification.
Main Results:
- Patients with cardiovascular disease exhibited a significantly higher number of RIPLs compared to healthy controls (2.8 vs. 0.8, p < 0.001).
- Each RIPL was independently associated with an increased odds of having cardiovascular disease (OR 1.60).
- Individuals with intermediate and high ASCVD risk scores showed a greater prevalence of RIPLs compared to those with low scores.
Conclusions:
- Retinal ischemic perivascular lesions (RIPLs) are anatomical markers of retinal ischemic infarcts and are suggestive of coexisting cardiovascular disease.
- Detection of RIPLs from routine retinal scans may offer an additional, noninvasive biomarker for identifying patients at risk of adverse cardiovascular events.
- This finding supports the potential utility of RIPLs in cardiovascular risk assessment and early disease detection.
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.
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