ARVO Annual Meeting Abstract, June 2024
Abstract
Purpose : The advent of deep learning (DL) algorithms has now made it possible to predict the risk of cardiovascular disease (CVD) using retinal images. We had previously developed a retina-based DL model, Reti-CVD, which successfully predicted future CVD incidents in a longitudinal study. According to US guidelines, adults with stage 1 hypertension (HTN) who have an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 10% or higher should be managed initially with blood pressure (BP) lowering medication. This study aims to investigate to use Reti-CVD score for decisions on BP-lowering medication among adults with stage 1 HTN.
Methods : Our study included 7664 adults with stage 1 HTN from the UK Biobank. Reti-CVD scores were calculated and categorized into two risk groups – low (n=6433), and high (n=1231), based on the same number of participants with 0 to 10% and ≥10% 10-year ASCVD risk according to Pooled Cohort Equation (PCE). To assess the Reti-CVD’s ability to predict fatal and non-fatal CVD events, we performed a survival analysis on the longitudinal data using Cox proportional-hazards models and hazard ratios (HRs).
Results : Among the 7664 participants with stage 1 HTN, 125 (1.6%) had nonfatal and fatal ASCVD events during the 10-year follow-up. Based on the standard of care (PCE), those with ≥10% ASCVD risk group (4.5 CVD incidence rate per 1000 person-years[IR]) showed significantly increased risk of ASCVD events (HR=3.87, 95%CI:2.71-5.53) compared with <10% ASCVD risk group (1.2-CVD IR). In comparison to the low-risk group (1.2-CVD IR), the high-risk group (4.2-CVD IR) of Reti-CVD was significantly associated with increased risk of ASCVD events (HR=3.48, 95%CI: 2.43-4.99) in the multivariable Cox model. The two-tier Reti-CVD (low- vs high-risk) showed prognostic performance with a concordance index of 0.620 (95%CI:0.577-0.663).
Conclusions : With DL, retinal photographs could be used as a surrogate marker for cardiovascular risk stratification for stage 1 HTN given its compatibility with the estimated 10-year ASCVD risk predictions from blood tests. Our findings suggest that contactless and non-invasive retinal photography may be adopted as a supportive and adjunctive modality to aid decision-making in starting BP-lowering medication for adults with stage 1 HTN, especially, patients who fail to meet the <130/80 mmHg treatment goal even after nonpharmacologic therapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.
