Retinal layer thickness as a potential marker for future cardiovascular events - a UK Biobank cohort study using optical coherence tomography

Abstract Aims Cardiovascular disease (CVD) is the leading cause of death worldwide. For CVD prevention, effective screening is needed to identify high-risk individuals. Optical coherence tomography (OCT) provides a noninvasive, low-cost “quick look” into the brain and has recently shown thinning of certain retinal layers in patients with previous CVD. We explored if OCT-derived retinal layer thicknesses could predict future major adverse cardiovascular events (MACE: stroke/myocardial infarction/cardiovascular death). Methods In this retrospective cohort study, data of 51,293 participants from the UK Biobank were analyzed. We used cause-specific hazard models to evaluate the association of retinal nerve fiber layer thickness (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness with incident MACE, adjusting models for cardiovascular risk factors (CVRF) and performed subanalyses for association with incident stroke and myocardial infarction. Results Median follow-up time was 14.7 years. Both RNFL thickness (aHR 0.92, 95% CI 0.89–0.96, p < 0.001) and GCIPL thickness (aHR 0.96, 95% CI 0.92–1.00, p = 0.04) were statistically associated with incident MACE in cause-specific hazard models adjusted for CVRF. Interestingly, RNFL thickness was more strongly associated with incident myocardial infarction (aHR 0.94, 95% CI 0.88–0.99, p = 0.02) while GCIPL was more strongly associated with incident stroke (aHR 0.90, 95% CI 0.83–0.96, p = 0.003). Conclusion RNFL and GCIPL thicknesses are associated with future MACE, even after adjusting for CVRF. OCT-measured retinal layer thickness could contribute to the assessment of cardiovascular risk. Graphical abstract Key question : Can measurement of retinal layer thickness by optical coherence tomography (OCT) improve prediction of incident cardiovascular events? Key finding : Retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness are associated with incident major adverse cardiovascular events (MACE). They lead to modest improvements in prediction of MACE when both layers were added to a cause-specific hazard model based on age and sex. Take-home message : Measures of retinal layer thickness using OCT have the potential to improve cardiovascular risk screening.