Heart disease is in the eye of the beholder

Researchers have identified a potential new marker that indicates the presence of cardiovascular disease, using an optical coherence tomography (OCT) – a non-invasive diagnostic tool, commonly used in ophthalmology and optometry clinics to create retinal images. The finding suggests that it may be possible to detect heart disease during an eye examination.

In the paper published on March 2, 2021 in EClinical Medicine by The Lancet, the research team examined retinal lesions, the most light-sensitive layer of the eye, to determine if a cardiovascular disorder may be present.

“The eyes are a window to our health and many diseases can manifest in the eye; cardiovascular disease is no exception,” said lead author Mathieu Bakhoum, a surgeon and researcher at UC San Diego Health. “Ischemia, which is a decrease in blood flow caused by heart disease, can lead to an inadequate blood flow to the eyes and can cause the death of retinal cells, leaving a permanent mark. We called this sign retinal ischemic perivascular injury or RIPL and the question arose as to whether this sign could serve as a biomarker for cardiovascular disease.”

Two groups were included in the study: one consisting of 84 people with heart disease and the other consisting of 76 healthy people, as a control group of the study. An increased number of RIPLs have been observed in the eyes of people with heart disease. According to the researchers, the higher number of RIPL in the eye indicates a higher risk of cardiovascular disease. “The only way we can see the smallest blood vessels in the body is in the eyes. The retina in particular provides important evidence of the adverse effects of cardiovascular problems, such as high blood pressure, “said Anthony DeMaria of UC San Diego Health.

DeMaria said detecting RIPLs could lead to the identification of cardiovascular diseases that would allow early therapy and preventative measures and could reduce the number of heart attacks or strokes.

A person’s risk of cardiovascular disease is determined by calculating the risk score for cardiovascular atherosclerotic disease, according to guidelines developed by the American College of Cardiology. The guide is considered the gold standard for assessing a patient’s 10-year risk of having a cardiovascular event, such as a heart attack or stroke. In the study, the researchers found a correlation between the number of RIPL in a patient’s eye and the cardiovascular risk score.

“People with low cardiovascular scores had low RIPL in their eyes, but as the risk increased, so did the number of RIPLs,” Bakhoum said.

Ophthalmologists at UC San Diego Health are now considering referring patients to a cardiologist if RIPLs are identified during an OCT scan. The research teams hope that this work and future studies will result in RIPLs becoming a common ophthalmic marker for identifying potential cardiovascular disease and will be incorporated into the overall ASCVD risk score.

“Globally, cardiovascular disease is the leading cause of death, and unfortunately many people do not know that they may have heart problems,” Bakhoum said. “The key here is early detection and treatment. We hope that with this new marker we can identify heart problems before a catastrophic event occurs, such as a heart attack or a stroke.”

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