Yoon YH, et al. Subclinical coronary atherosclerosis and retinal optical coherence tomography angiography: observational cohort study. Presented at the American Society of Retina Specialists Annual Meeting; July 13-16, 2022; New York.

Disclosures: Yoon reports speaking and consulting for Alcon, Allergan, Bayer and Roche; serve on the advisory board of Allergan, Bayer and Roche; and as an investigator for Allergan, Amgen, Bayer, Celltrion, Novartis, Samsung Bioepis and Roche.

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NEW YORK – In patients with type 2 diabetes, a reduction in retinal parafoveal vascular density may indicate coronary insufficiency and the potential for a cardiac event, according to a presenter.

“Coronary artery disease (CAD) is the leading cause of death in diabetic patients, and 25% of patients with diabetic retinopathy have significant stenotic coronary artery disease. We hypothesized that retinal microvascular perfusion might reflect cardiovascular status,” Young Hee Yoon, MD, PhD, said at the annual meeting of the American Society of Retina Specialists.

Yoon mug

Young Hee Yoon

In one study, the association between OCT angiography (OCTA), microvascular parameters, and risk of subclinical coronary artery disease was assessed in 654 patients with type 2 diabetes who were receiving ophthalmic care. They underwent a detailed ophthalmologic examination including OCTA (AngioVue, Optovue) and assessment of coronary risk by identification of arteriosclerosis by CT coronary angiography. The average age of the patients was 65 years, more than 40% had a history of smoking and two-thirds suffered from hypertension. The mean parafoveal (RV) vascular density was 43.7 at the superficial capillary plexus (SCP) and 48.1 at the deep capillary plexus (DCP).

“About 35% had obstructive coronary artery disease and 15% had high-risk coronary artery disease. The mean coronary artery calcium score was 241, with 34% of patients scoring above 100. Statistical analysis showed a correlation significant with SCP and DCP parafoveal RV,” Yoon said.

Patients were then categorized by parafoveal RV into four quartiles, ranging from high RV (quartile one) to low RV (quartile four). Among baseline characteristics, low RV quartiles were associated with older age and more advanced stage of diabetic retinopathy.

“The risk of obstructive coronary artery disease and high-risk coronary artery disease was significantly higher among the low vascular density SCP and DCP quartile groups,” Yoon said. “The higher risk remained significant even after adjusting for age, gender and [cardiovascular] risk factors including age, gender, hypertension, smoking history and hyperlipidemia.

Coronary screening may therefore be beneficial in diabetic patients with low parafoveal RV to detect subclinical coronary artery disease, she said.


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