The retina, this thin membrane that lines the inner surface of the eyeball, is often considered a window into our brain, as demonstrated by several studies. But, according to researchers at the University of Edinburgh, it would also be very useful to predict the risk of heart attack (or myocardial infarction) thanks to a simple routine exam. Their study was presented at the annual conference of the European Society for Human Genetics and indicates that combining information about the pattern of blood vessels in the retina with genetic data and known traditional clinical factors can accurately predict an individual’s risk of coronary heart disease (a disease of the arteries that supply the heart, the coronary arteries) and its potentially fatal outcome, myocardial infarction. Eventually, this finding could lead to a simple screening process, where the risk of myocardial infarction can be calculated when a person undergoes a routine eye exam.
” We already knew that variations in the retinal vasculature can offer insights into our health. As retinal imaging is a non-invasive technique, we decided to investigate the health benefits we could get from these images. First, we study the branching patterns of the retinal vasculature by calculating a measure called fractal dimension (Df) from data available from the UK Biobank (UKB) says Professor Ana Villaplana-Velasco, a doctoral student at the University of Edinburgh’s Usher and Roslin Institutes and lead author of the study. UK Biobank includes demographic, clinical, medical imaging and genotyping data from over 500,000 participants across the UK. The researchers used it to develop a statistical prediction model capable of estimating the risk of myocardial infarction by studying data from UKB participants who suffered such an event after collecting their retinal images.
Each condition may have a unique profile of retinal variation
The model included this measurement of fractal dimension along with traditional clinical factors such as age, gender, systolic blood pressure, body mass index (BMI), and smoking to develop a personalized risk score. “ Surprisingly, we found that our model was able to better classify participants at low or high risk of myocardial infarction in the UKB compared to established models that only include demographic data. The improvement in our model was even greater if we added a score related to the genetic propensity to develop a heart attack..”, adds Professor Villaplana-Velasco. The researchers then wondered if there was a shared genetic basis between fractal dimension and myocardial infarction, and then discovered the existence of nine genetic regions that cause retinal vascular branching patterns. However, four of these regions are known to be involved in the genetics of cardiovascular disease.
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In particular, the scientific team found that these common genetic regions are involved in processes related to myocardial infarction severity and recovery. These results may also be useful in identifying propensity for other diseases. Because, based on this observation, variations in the vascular pattern of the retina may also reflect the risk of developing other diseases, such as diabetic retinopathy and stroke. Researchers believe that each condition has a unique pattern of retinal variation. “ We would like to explore this issue further and carry out a gender-specific analysis. We know that women at high risk of heart attack tend to have pronounced retinal vascular shifts compared to the male population. We would like to repeat our analysis separately in men and women to determine whether a sex-specific model of infarction complements a better risk classification. “, observes Professor Villaplana-Velasco.
Target people whose cardiovascular risk needs to be reduced upstream
Knowing that the average age of a heart attack is 60 years, the researchers also found that their model achieved its best predictive performance more than five years before a heart attack occurred. They hope that in the future, a simple retinal scan will be able to provide enough information to identify people at risk very early on. According to the expert, calculating an individualized risk of heart attack above 50 seems appropriate. This would allow doctors to suggest to affected patients behaviors that could reduce this risk, such as quitting smoking and maintaining normal cholesterol and blood pressure levels. To reduce your cardiovascular risk, you should eat a balanced diet as much as possible, eating fish, fruits and vegetables often and avoiding a very high fat diet. In addition to quitting smoking, regular physical activity is essential to reduce physical inactivity and thus limit weight gain.
It is noteworthy, however, that the study in question has not yet been the subject of peer-validated scientific publication: it is currently pre-published on MedRxiv and retransmitted by the journal The Guardian.The latter also questioned the British Heart Association about this finding and its medical director, Professor Sir Nilesh Samani, states that “ more research is needed to show that this prediction improvement is robust. Work will also be needed to understand the feasibility of this approach and determine how best to integrate these analyzes into routine clinical practice. ” Same warning as Dr James Ware, a cardiologist at Imperial College London who nevertheless estimated ” It is well known that the retina offers a unique opportunity to assess vascular health. Approaches like this, which use computer vision and/or machine learning to detect subtle vascular features that predict heart health, hold promise. »