Reduced Retinal Parafoveal Vascular Density Linked to Subclinical Coronary Atherosclerosis: JAMA
South Korea: Researchers have found in a new cross-sectional cohort study that reduced retinal parafoveal vascular density was independently associated with subclinical coronary atherosclerosis in individuals with elevated vascular risk. This suggests that decreased parafoveal vascular density may indicate greater atherosclerotic burden and help identify patients needing further coronary evaluation beyond traditional risk factors.
The investigation, published in JAMA Cardiology and led by Dr. Jee Myung Yang of the Department of Ophthalmology at Asan Medical Center, University of Ulsan College of Medicine in Seoul, evaluated whether a simple, noninvasive eye scan could provide insights into hidden heart disease. Optical coherence tomography angiography (OCTA), which captures detailed images of the retinal microvasculature, was used to assess its relationship with coronary atherosclerosis detected through coronary computed tomography angiography (CTA).
Between October 2015 and December 2020, the researchers studied 1,286 asymptomatic adults who had elevated cardiovascular risk and voluntarily underwent both OCTA and coronary CTA. Participants had a mean age of 64 years, and about 38% were women. Coronary artery calcium scores, plaque presence, obstructive coronary artery disease (CAD), severe CAD, segment stenosis scores, and segment involvement scores were all closely linked to parafoveal vascular density (PFVD) in both the superficial and deep retinal layers.
Key Findings:
- Lower parafoveal vascular density (PFVD) measurements showed a linear inverse association with coronary artery disease (CAD) burden.
- Individuals in the lowest quartile of superficial capillary plexus PFVD had nearly three times the odds of obstructive CAD compared with those in the highest quartile.
- The same group also had more than three times the odds of severe CAD compared with the highest quartile.
- Similar but slightly weaker associations were observed for the deep capillary plexus PFVD.
- Incorporating PFVD into standard cardiovascular risk models significantly improved the identification of severe and obstructive CAD.
- Superficial capillary plexus PFVD outperformed deep capillary plexus PFVD in predicting CAD severity and obstruction.
The findings highlight the retina as a window to systemic vascular health. Patients taking part in the study who had reduced PFVD also tended to have higher coronary calcium scores and more extensive coronary plaque, underscoring the close link between microvascular changes in the eye and atherosclerotic disease in the heart.
The authors acknowledged several limitations, including the single-center design, a largely homogenous Korean population, and the exclusion of patients with advanced macular disease or high myopia, which could affect OCTA imaging. They also noted that coronary plaque characteristics were not assessed and that the analysis did not distinguish between retinal arteries, veins, and capillaries.
"Despite these constraints, the study provides strong evidence that retinal microvasculature imaging can serve as a complementary marker for subclinical coronary atherosclerosis. Incorporating OCTA-based PFVD measurements with traditional cardiovascular risk assessments may help identify asymptomatic individuals who would benefit from more detailed cardiac evaluation, offering a noninvasive and accessible tool to detect heart disease before symptoms arise," the authors concluded.
Reference:
Yang JM, Yang DH, Lee S, et al. Subclinical Coronary Atherosclerosis and Retinal Optical Coherence Tomography Angiography. JAMA Cardiol. Published online September 17, 2025. doi:10.1001/jamacardio.2025.3036
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