Anatomical Correlation Between Retinal Microvasculature and Coronary Artery Disease in a Pakistani Population.

Authors

  • Farrakh Jamil
  • Shabiha Naeem
  • Muhammad Saqib Baloch
  • Mansoor Mukhtar Qazi
  • Naeem Shahzad
  • Mashhood Shahid Amin Hashmi

DOI:

https://doi.org/10.63682/jns.v14i32S.10155

Keywords:

Retinal microvasculature anatomy, Coronary artery disease, Fundus photography, Cardiovascular risk assessment

Abstract

Background: The retinal microvasculature shares structural and physiological similarities with the coronary circulation and may provide a non-invasive window to assess systemic vascular pathology. Retinal vascular changes have increasingly been investigated as potential indicators of cardiovascular disease. This study aimed to evaluate the association between retinal microvascular anatomical changes and coronary artery disease (CAD) in a Pakistani population.

Methods: A cross-sectional study was conducted at a tertiary care hospital in Pakistan including 120 participants aged 40–70 years. Sixty patients with angiographically confirmed coronary artery disease were included in the case group, while sixty age- and sex-matched individuals without known cardiovascular disease served as controls. Fundus examination and digital retinal photography were performed to assess retinal vascular parameters including arteriolar narrowing, arteriovenous (AV) nicking, vascular tortuosity, and retinal hemorrhages. Data were analyzed using descriptive and comparative statistical methods.

Results: Retinal vascular abnormalities were significantly more frequent in patients with CAD compared with controls. Arteriolar narrowing was observed in 38 patients (63.3%) in the CAD group compared to 14 individuals (23.3%) in the control group. AV nicking was present in 31 patients (51.7%) with CAD versus 11 controls (18.3%). Increased retinal vascular tortuosity was detected in 26 CAD patients (43.3%) compared to 9 individuals (15.0%) in the control group. Retinal hemorrhages were identified in 12 patients (20.0%) with CAD, while only 3 participants (5.0%) in the control group demonstrated similar findings. The presence of multiple retinal microvascular changes was significantly associated with established coronary artery disease.


Conclusion: Retinal microvascular anatomical changes were markedly more prevalent in patients with coronary artery disease in this Pakistani cohort. These findings support the concept that retinal vascular examination may serve as a useful, non-invasive tool for identifying individuals at increased risk of cardiovascular disease. Incorporating retinal vascular assessment into routine clinical evaluation may enhance early detection and risk stratification in populations with high cardiovascular burden..

Downloads

Download data is not yet available.

References

1. World Health Organization. Cardiovascular diseases (CVDs). Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases(cvds)

2. Safiri S, Karamzad N, Singh K, Carson-Chahhoud K, Adams C, Nejadghaderi SA, et al. Global burden of ischemic heart disease and its attributable risk factors from 1990 to 2019. Lancet Reg Health Eur. 2021;3:100138.

3. Poplin R, Varadarajan AV, Blumer K, Liu Y, McConnell MV, Corrado GS, et al. Prediction of cardiovascular risk factors from retinal fundus photographs using deep learning. Nat Biomed Eng. 2021;5(1):35-45.

4. Cheung CY, Ikram MK, Sabanayagam C, Wong TY. Retinal microvasculature as a model to study the manifestations of systemic vascular diseases. Prog Retin Eye Res. 2021;82:100907.

5. Rusu AC, Horvath KU, Tinica G, Bulgaru-Iliescu A. Retinal structural and vascular changes in patients with coronary artery disease: A systematic review and meta-analysis. Life (Basel). 2024;14(4):448.

6. Zhang W, Guo X, Jiang X, Han X. Retinal microvascular changes and risk of coronary heart disease: A systematic review and meta-analysis. Retina. 2024;44(2):256-264.

7. Yao Y, Wang Q, Yang J, Liu Y, Chen Y. Associations of retinal microvascular alterations with systemic diseases using optical coherence tomography angiography. BMC Ophthalmol. 2024;24:245.

8. Oto B, Kılıçarslan O, Kayadibi Y, Demirci H. Retinal microvascular changes in internal carotid artery stenosis detected using optical coherence tomography angiography. J Clin Med. 2023;12(18):6014.

9. Chua J, Chin CWL, Hong J, Chee ML, Wong TY. Impact of systemic cardiovascular disease on retinal microvascular architecture using optical coherence tomography angiography. J Clin Med. 2023;12(3):829.

10. Sabanayagam C, Cheung CY, Banu R, Cheng CY, Wong TY. Retinal microvascular biomarkers for cardiovascular disease risk prediction. Prog Cardiovasc Dis. 2022;70:6-15.

11. Al-Fiadh AH, Farouque O, Kawasaki R, Wong TY. Retinal microvascular parameters and coronary artery disease severity assessed by optical coherence tomography angiography. Acta Ophthalmol. 2021;99(7):e1117-e1124.

12. Cheung CY, Xu D, Cheng CY, Sabanayagam C, Wong TY. Retinal vascular imaging as a biomarker for systemic cardiovascular diseases. Prog Retin Eye Res. 2022;89:101036.

13. McGrory S, Ballerini L, Doubal FN, Valdés Hernández MC, MacGillivray TJ, Wardlaw JM. Retinal microvasculature and cardiovascular disease risk: A review. Hypertension. 2022;79(9):1789-1798.

14. Wang JJ, Liew G, Klein R, Mitchell P, Wong TY. Retinal vessel calibre and cardiovascular outcomes in population-based studies. Lancet Digit Health. 2022;4(2):e110-e119.

15. Chen KY, Chan HC, Chan CM. Association between retinal vein occlusion and myocardial infarction: A systematic review and meta-analysis. Int J Retina Vitreous. 2024;10:18.

16. Zhang W, Guo X, Han X. Retinal vascular abnormalities as predictors of coronary heart disease. Retina. 2024;44(4):712-720.

17. Rusu AC, Horvath KU, Bulgaru-Iliescu A, Tinica G. Retinal microvascular imaging as a biomarker in coronary artery disease. Life (Basel). 2024;14(4):448.

18. Bayat K, Pooyan P, Chhablani J, Al-Qahtani A. Retinal and choroidal alterations in heart failure: A systematic review and meta-analysis. Ophthalmol Ther. 2025;14:345-358.

19. Haq ZU, Shah SA, Khan A, et al. Artificial intelligence-based retinal imaging for cardiovascular risk prediction. Front Cardiovasc Med. 2023;10:1132451.

20. Ong YT, Sabanayagam C, Cheung CY, Wong TY. Retinal vascular imaging in systemic disease screening. Nat Rev Cardiol. 2022;19(2):85-101.

21. Ballerini L, Trucco E, Doubal FN. Retinal vascular biomarkers for systemic cardiovascular disease detection. Front Med (Lausanne). 2023;10:1183024.

Downloads

Published

2025-10-07

How to Cite

1.
Jamil F, Naeem S, Saqib Baloch M, Mukhtar Qazi M, Shahzad N, Amin Hashmi MS. Anatomical Correlation Between Retinal Microvasculature and Coronary Artery Disease in a Pakistani Population. J Neonatal Surg [Internet]. 2025 Oct. 7 [cited 2026 May 22];14(32S):10783-7. Available from: https://jneonatalsurg.com/index.php/jns/article/view/10155

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.