Group with Lower Retinal Vascular Density Faces Up to Threefold Higher Risk of Atherosclerosis

Asan Medical Center Research Team Publishes Findings in World-Renowned Journal ‘JAMA Cardiology‘ (Impact Factor 14.1)

“Retinal Vascular Examination May Serve as a New Method for Early Detection of Cardiovascular Disease”

▲ (From left) Professors Young Hee Yoon and Jee Myung Yang from the Department of Ophthalmology, Seung-Whan Lee from the Division of Cardiology, and Dong Hyun Yang from the Department of Radiology at Asan Medical Center

The retina is the only organ in the human body where blood vessels can be directly observed. A recent study has found that the distribution or density of retinal blood vessels may serve as an indicator of cardiovascular disease risk.

A research team led by Professors Young Hee Yoon and Jee Myung Yang from the Department of Ophthalmology, Seung-Whan Lee from the Division of Cardiology, and Dong Hyun Yang from the Department of Radiology at Asan Medical Center conducted a study on 1,286 adults who underwent retinal vascular imaging due to ophthalmic conditions and had a family history or other risk factors for cardiovascular disease. The study found that individuals with the lowest retinal vascular density had up to three times higher risk of atherosclerosis, or narrowing of the coronary arteries, compared to those with the highest vascular density.

Atherosclerosis refers to the gradual narrowing of the coronary arteries, which supply blood to the heart, due to the buildup of fat, cholesterol, and other substances. If the condition persists, it can lead to reduced oxygen supply to the heart and brain. When an atherosclerotic plaque ruptures and suddenly blocks the blood vessel, it can result in life-threatening conditions such as myocardial infarction or cerebral infarction.

Based on the study findings, individuals with lower retinal vascular density may be able to assess their cardiovascular risk and undergo additional cardiac examinations in clinical settings, enabling early diagnosis and prevention of cardiovascular disease.

The study was published in the latest issue of the world-renowned journal ‘JAMA Cardiology’ (Impact Factor 14.1).

The research team analyzed data from 1,286 adults who underwent retinal vascular imaging using optical coherence tomography angiography (OCTA) for ophthalmic conditions, among patients who had received coronary computed tomography (CT) scans between 2015 and 2020 due to cardiovascular risk factors such as family history or lifestyle habits.

The results showed that lower retinal vascular density was significantly associated with higher levels of atherosclerotic indicators such as coronary calcium score, presence of plaques, and degree of arterial stenosis. In particular, the superficial capillary plexus—a layer of capillaries that forms a mesh-like network near the surface of the retina—was identified as a strong predictor of atherosclerosis.

The group with the lowest vascular density in the superficial capillary plexus had more than three times higher risk of developing atherosclerosis compared to the group with the highest density. Specifically, the risk of obstructive coronary artery disease (narrowing of more than 50 percent) was about 2.9 times higher, the risk of severe coronary artery disease (narrowing of 70 to 90 percent) was about 3.3 times higher, and the risk of significant arterial stenosis increased threefold.

While blood vessels in most organs can only be observed through invasive procedures, retinal blood vessels in the eye can be directly examined with a simple imaging test. A lower retinal vascular density indicates that systemic blood flow may be reduced. The research team interpreted that retinal vascular density is correlated with coronary circulation and may serve as an indicator reflecting the risk of cardiovascular disease.

▲ Professor Jee Myung Yang from the Department of Ophthalmology at Asan Medical Center explains the results of a retinal vascular examination to a patient.

Professor Young Hee Yoon of the Department of Ophthalmology at Asan Medical Center said, “This study is significant in that it is the first large-scale analysis to evaluate whether retinal vascular imaging can predict coronary atherosclerosis in asymptomatic adults. Because retinal vascular examination can be easily incorporated into routine ophthalmologic care, it is expected to become a new method for the early detection of cardiovascular disease in the future.”

Professor Seung-Whan Lee of the Division of Cardiology at Asan Medical Center stated, “Coronary atherosclerosis is particularly dangerous because it often remains asymptomatic until blood flow is suddenly blocked. Even if symptoms are not present, individuals with a family history or lifestyle factors that increase cardiovascular risk, or those with decreased retinal vascular density, may already have progressing atherosclerosis detectable on coronary CT scans. Therefore, regular checkups and appropriate treatment are strongly recommended.”