Something in your eyes could tell if you’re at risk for heart disease or premature death, new research suggests

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A new study published in the journal BMJ today claims that your eyes can potentially predict the possibility of developing heart disease.

The team found that the network of veins and arteries in the retina can reliably predict cardiovascular disease and death without resorting to blood tests or blood pressure readings.

Enables accurate non-invasive screening tests that do not need to be done in a clinic.

Results of a study published online in the British Journal of Ophthalmology show that AI-enabled imaging of the retinal vein and artery network can effectively predict cardiovascular disease and death without the need for testing blood tests or blood pressure measurements.

Circulatory diseases, which include cardiovascular disease, coronary heart disease, heart failure and stroke, are leading causes of ill health and death worldwide. In the UK alone, circulatory disorders are responsible for one in four deaths.

Although there are a number of risk frameworks, researchers say they are not always reliable in predicting who will eventually develop or die from circulatory disorders.

According to previously published research, the size of the microscopic arteries and veins in the retina (called arterioles and venules), which collect and organize visual information, may serve as a reliable early indicator of cardiovascular disease.

However, it is unclear whether these findings are consistently and equally true for men and women.

To create models to assess the potential of retinal vascular imaging combined with known risk factors to predict vascular health and death, researchers created a fully automated artificial intelligence (AI)-enabled algorithm called QUANTitative Analysis of Retinal vessels Topology and size, or QUARTZ for short.

They used QUARTZ to analyze the width, vascular area and degree of tortuosity (curvature) of retinal arterioles and venules of 88,052 UK Biobank participants aged 40-69 to create predictive models for strokes, heart attacks and mortality from circulatory disease.

After that, they used the patterns on the retinal scans of 7,411 people aged 48 to 92 who participated in the European Prospective Investigation into Cancer (EPIC)-Norfolk research.

Both individually and collectively, the effectiveness of QUARTZ has been compared to the widely used Framingham risk score system.

During the average follow-up period of 7 to 9 years, 327 people with circulatory disease died among the 64,144 participants in the UK biobank (average age 56 years), while 201 people with circulatory disease died among the 5,862 EPIC-Norfolk participants (mean age 67).

The width of arteriolar and venular walls, as well as their tortuosity and variation in width, have been found to be strong predictors of death from cardiovascular disease in men. In women, the area and width of arteries and veins, as well as the shape and width of veins, predicted risk.

The prognostic influence of retinal vasculature on circulatory disease mortality interacted with smoking, blood pressure medications, and prior heart attack.

Overall, between half and two-thirds of circulatory disease deaths in those most at risk were predicted by these predictive models, which were based on age, smoking status, medical history and retinal vasculature.

Additionally, retinal vasculature models identified 3% more incidences of stroke in most-at-risk EPIC-Norfolk men, 5% more cases in UK Biobank women, and about 2% fewer cases among men in EPIC-Norfolk. Additionally, among those most at risk, Framingham risk scores detected more heart attacks.

Only minor adjustments were made to the Framingham risk scores to better predict the risk of stroke and heart attack. However, the researchers say a less complex, noninvasive risk score based on age, sex, smoking status, medical history, and retinal vasculature outperformed Framingham risk scores while requiring no blood tests or blood pressure measurements.

They acknowledge that both research groups have healthier lifestyles than other middle-aged adults in similar geographies, the majority of whom are white. However, they note that this is the largest population-based survey of the retinal vasculature and that a significant percentage of patients underwent external validation of the prediction models.

The researchers note that retinal imaging is already standard procedure in the US and UK. They conclude that “AI-based vasculometry risk prediction is fully automated, inexpensive, noninvasive, and has the potential to reach a higher proportion of the population in the community due to street-level availability” and because blood sampling or [blood pressure measurement] are not necessary.

According to them, “[Retinal vasculature]is a microvascular marker, therefore offers a better prediction of circulatory mortality and stroke compared to [heart attack] which is more macrovascular, except perhaps in women.

“In the general population, it could be used as a non-contact form of systemic vascular health checkup, to triage those at medium to high risk of circulatory mortality for further clinical risk assessment and appropriate intervention.”

They propose that it be incorporated into the primary care NHS health check for people aged 41 to 74 in the UK.

Drs. Ify Mordi and Emanuele Trucco of the University of Dundee in Scotland write in a related editorial that although the use of retinal vasculature alterations to assess overall cardiovascular risk is “certainly appealing and intuitive”, it has not yet reached clinical practice.

They speculate that this method of retinal screening would “likely require a significant increase in the number of ophthalmologists or otherwise trained evaluators”, and they ask which specialty would be responsible for the additional workload and preventive care: ophthalmologists, cardiologists or practitioners primary care.

The authors write that “what is needed now is for ophthalmologists, cardiologists, primary care physicians, and computer scientists to work together to design studies to determine whether using this information improves clinical outcomes. and, where appropriate, to work with regulatory agencies, scientific societies, and health systems to improve clinical workflows and enable practical implementation in routine practice.

Source: 10.1136/bjophthalmol-2022-321842

Image Credit: Getty

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