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. 2025 Nov 1;10(11):1100-1111.
doi: 10.1001/jamacardio.2025.3036.

Subclinical Coronary Atherosclerosis and Retinal Optical Coherence Tomography Angiography

Jee Myung Yang  1 , Dong Hyun Yang  2 , Seung-Whan Lee  3 , Jiehoon Kwak  1   4 , Yunhan Lee  1 , Yoon Jeon Kim  1 , Joo Yong Lee  1 , Kyung Rim Sung  1 , Young Hee Yoon  1
Affiliations

Subclinical Coronary Atherosclerosis and Retinal Optical Coherence Tomography Angiography

Jee Myung Yang et al. JAMA Cardiol. .

Abstract

Importance: Systemic disease burden is well reflected in the retinal microvasculature, but it is not established whether optical coherence tomography angiography (OCTA) parameters can reliably reflect coronary atherosclerosis.

Objective: To assess the association of reduced retinal vascular density and subclinical coronary atherosclerosis in asymptomatic individuals.

Design, setting, and participants: This cross-sectional cohort study included asymptomatic individuals with elevated cardiovascular risk who self-referred for a health screening program involving coronary computed tomography angiography (CTA) at Asan Medical Center in Seoul, South Korea, and subsequently underwent OCTA as part of ophthalmic evaluations. This study was conducted from October 2015 to December 2020, and data analysis was conducted from January 2021 to May 2025.

Main outcomes and measures: The primary outcome was the association between OCTA parameters and coronary CTA parameters.

Results: A total of 1286 eyes from 1286 participants were analyzed (mean [SD] age, 64.2 [9.9] years; 482 female participants [37.5%]). Coronary artery calcium score (CACS), presence of plaque and its subtypes, obstructive coronary artery disease (CAD), severe CAD, segment stenosis score (SSS), and segment involvement score (SIS) were significantly increased across the quartiles of superficial and deep parafoveal vascular density (PFVD). When modeled as continuous variables, superficial capillary plexus (SCP) and deep capillary plexus (DCP) PFVD were the most significant metrics and correlated with CACS, number of coronary vessels involved, SSS, and SIS. The lowest quartile of SCP PFVD was associated with significantly higher odds of obstructive CAD (adjusted odds ratio [aOR], 2.91; 95% CI, 1.83-4.73), severe CAD (aOR, 3.30; 95% CI, 1.55-7.91), and elevated SSS and SIS scores compared to the highest quartile. Similar but attenuated associations were observed for DCP PFVD. Continuous variable analysis for ORs for unit increase supported a linear inverse association between PFVD and CAD burden. Incorporating PFVD into models with cardiovascular risk factors improved area under the curve (AUC) for identifying severe CAD (AUC, 0.79; 95% CI, 0.75-0.82), obstructive CAD (AUC, 0.78; 95% CI, 0.76-0.81), and SSS of 10 or higher (AUC, 0.77; 95% CI, 0.74-0.80), with SCP yielding superior performance over DCP.

Conclusions and relevance: In this cross-sectional cohort study, reduced retinal PFVD was independently associated with subclinical coronary atherosclerosis in a population with elevated vascular risk. 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Yoon reported grants from Allergan, Bayer, Celltrion, Novartis, Opthea, Roche, and Samsung Bioepis and personal fees from Allergan, Bayer, Iveric Bio, Roche, and Samsung Bioepis outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association Between Retinal Parafoveal Vascular Density and Subclinical Coronary Atherosclerosis
Logistic regression analyses using quartile (Q) of superficial capillary plexus parafoveal vascular density (PFVD) (A) and deep capillary plexus PFVD (B). Reference is Q4. CACS indicates coronary artery calcium score; CAD, coronary artery disease; OR, odds ratio; SIS, segment involvement score; SSS, segment stenosis score.
Figure 2.
Figure 2.. Schematic Summary and Representative Cases of Retinal Parafoveal Vascular Density and Coronary Computed Tomography Angiography
No coronary artery disease (CAD) (A), partial obstructive CAD (B), and severe obstructive CAD (C). DCP indicates deep capillary plexus; LAD, left anterior descending coronary artery; LCX, left circumflex artery; RCA, right coronary artery; SCP, superficial capillary plexus; Q, quartile.
See this image and copyright information in PMC

References

    1. 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. doi: 10.1016/j.jcmg.2016.01.040 - DOI - PubMed
    1. Thomas DM, Divakaran S, Villines TC, et al. Management of coronary artery calcium and coronary CTA findings. Curr Cardiovasc Imaging Rep. 2015;8(6):18. doi: 10.1007/s12410-015-9334-0 - DOI - PMC - PubMed
    1. Min JK, Shaw LJ, Devereux RB, et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50(12):1161-1170. doi: 10.1016/j.jacc.2007.03.067 - DOI - PubMed
    1. Yang JM, Park CS, Kim SH, et al. Dll4 suppresses transcytosis for arterial blood-retinal barrier homeostasis. Circ Res. 2020;126(6):767-783. doi: 10.1161/CIRCRESAHA.119.316476 - DOI - PubMed
    1. Lee J, Moon BG, Cho AR, Yoon YH. Optical coherence tomography angiography of DME and its association with anti-VEGF treatment response. Ophthalmology. 2016;123(11):2368-2375. doi: 10.1016/j.ophtha.2016.07.010 - DOI - PubMed