{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:45:25Z","timestamp":1768283125138,"version":"3.49.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of global mortality, particularly among individuals with dyslipidemia. Traditionally, the retina has been considered a key site for examining microvascular changes. Recent evidence, however, indicates that retinal alterations may also reflect macrovascular changes. This study proposes a hypothesis in which Optical Coherence Tomography Angiography (OCTA) is utilized to evaluate retinal vascular changes as a potential biomarker for ASCVD risk assessment in dyslipidemia patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cross-sectional study, 261 dyslipidemia patients were recruited and classified into non-ASCVD and ASCVD groups. OCTA was performed on all patients, with the macula and optic disc being the primary areas of assessment. The following parameters were measured: retinal vessel density (VD), retinal nerve fiber layer (RNFL) thickness, retinal thickness, foveal avascular zone (FAZ) area, FAZ perimeter, and VD within a 300\u2005\u03bcm width ring surrounding the FAZ (FD). Ultimately, data from 231 eyes were analyzed. Comparisons of OCTA-derived metrics between groups were made, and receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminatory power of these metrics for identifying ASCVD in dyslipidemia patients. The DeLong test was used to compare areas under the ROC curve for these indicators. All statistical tests were two-tailed, with significance set at <jats:italic>P<\/jats:italic>\u2009<jats:italic>&amp;lt;<\/jats:italic>\u20090.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the ASCVD group, RNFL thickness, superficial capillary plexus (SCP) parafoveal VD, SCP perifoveal VD, macular parafoveal thickness, and FD were significantly lower compared to the non-ASCVD group. ROC curve analysis confirmed the predictive value of these indicators for ASCVD identification in dyslipidemia patients. SCP parafoveal VD, SCP perifoveal VD, and FD correspond to the macular superficial capillary plexus vessel densities. When combined, these indicators formed a new composite measure, macular superficial vessel density (MSVD). The ROC curve further validated MSVD's predictive utility for ASCVD in dyslipidemia patients, with the optimal threshold identified at 143.22% using the Youden index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>OCTA-derived indicators, particularly MSVD, demonstrate significant potential as novel biomarkers for ASCVD risk assessment in dyslipidemia patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1634816","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T16:04:26Z","timestamp":1757693066000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Retinal vascular alterations as assessment indicators of atherosclerotic cardiovascular disease risk in dyslipidemia patients"],"prefix":"10.3389","volume":"12","author":[{"given":"Yu","family":"He","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guo-hong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-zhao","family":"Qin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Cao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-peng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Jiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-bao","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"621","DOI":"10.26599\/1671-5411.2023.09.008","article-title":"2023 China guidelines for lipid management","volume":"20","author":"Li","year":"2023","journal-title":"J Geriatr Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk","volume":"41","author":"Mach","year":"2020","journal-title":"Eur Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3168","DOI":"10.1016\/j.jacc.2018.11.002","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"73","author":"Grundy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"589","DOI":"10.3760\/cma.j.cn112148-20240325-00168","article-title":"Chinese Guidelines for the diagnosis and management of patients with chronic coronary syndrome","volume":"52","year":"2024","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"B6","author":"Party","year":"2023"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur Heart J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1161\/CIRCULATIONAHA.116.022367","article-title":"Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population: the China-PAR project (prediction for ASCVD risk in China)","volume":"134","author":"Yang","year":"2016","journal-title":"Circulation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2886","DOI":"10.1016\/j.jacc.2013.11.002","article-title":"2013 ACC\/AHA guideline on the assessment of cardiovascular risk","volume":"63","author":"Andrus","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e596","DOI":"10.1161\/CIR.0000000000000678","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"ii1","DOI":"10.1136\/heartjnl-2014-305693","article-title":"Joint British Societies\u2019 consensus recommendations for the prevention of cardiovascular disease (JBS3)","volume":"100","author":"Board","year":"2014","journal-title":"Heart"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1364\/BOE.10.001532","article-title":"Retinal and choroidal vascular changes in coronary heart disease: an optical coherence tomography angiography study","volume":"10","author":"Wang","year":"2019","journal-title":"Biomed Opt Express"},{"key":"B13","doi-asserted-by":"publisher","first-page":"4299","DOI":"10.1167\/iovs.18-24090","article-title":"The EYE-MI pilot study: a prospective acute coronary syndrome cohort evaluated with retinal optical coherence tomography angiography","volume":"59","author":"Arnould","year":"2018","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B14","volume-title":"Atlas of Optical Coherence Tomography Angiography","author":"Wen-bin","year":"2016"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1016\/j.survophthal.2021.11.002","article-title":"Optical coherence tomography (OCT) angiolytics: a review of OCT angiography quantitative biomarkers","volume":"67","author":"Kalra","year":"2022","journal-title":"Surv Ophthalmol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/1120672119880390","article-title":"Optical coherence tomography angiography and arterial hypertension: a role in identifying subclinical microvascular damage?","volume":"31","author":"Donati","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.ophtha.2016.10.008","article-title":"Quantification of diabetic macular ischemia using optical coherence tomography angiography and its relationship with visual acuity","volume":"124","author":"Samara","year":"2017","journal-title":"Ophthalmology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s12944-024-02287-7","article-title":"Assessment of the impact of low-density lipoprotein cholesterol on retinal vessels using optical coherence tomography angiography","volume":"23","author":"He","year":"2024","journal-title":"Lipids Health Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1136\/bjophthalmol-2016-308764","article-title":"Repeatability of automated vessel density measurements using optical coherence tomography angiography","volume":"101","author":"Al-Sheikh","year":"2017","journal-title":"Br J Ophthalmol"},{"key":"B21","volume-title":"Gray\u2019s Anatomy: The Anatomical Basis of Clinical Practice","author":"Susan","year":"2015"},{"key":"B22","doi-asserted-by":"publisher","first-page":"15163","DOI":"10.1038\/s41598-018-33580-y","article-title":"Novel classification of early-stage systemic hypertensive changes in human retina based on OCTA measurement of choriocapillaris","volume":"8","author":"Takayama","year":"2018","journal-title":"Sci Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s00592-021-01844-1","article-title":"Diabetic macular ischemia","volume":"59","author":"Tombolini","year":"2022","journal-title":"Acta Diabetol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1038\/s41433-020-01233-y","article-title":"Optical coherence tomography angiography in diabetic retinopathy: an updated review","volume":"35","author":"Sun","year":"2021","journal-title":"Eye (Lond)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1016\/j.jacc.2014.06.1186","article-title":"A systematic examination of the 2013 ACC\/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease","volume":"64","author":"Karmali","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1001\/jama.2014.2632","article-title":"Comparison of application of the ACC\/AHA guidelines, adult treatment panel III guidelines, and European society of cardiology guidelines for cardiovascular disease prevention in a European cohort","volume":"311","author":"Kavousi","year":"2014","journal-title":"JAMA"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1001\/jama.2014.2630","article-title":"Validation of the atherosclerotic cardiovascular disease pooled cohort risk equations","volume":"311","author":"Muntner","year":"2014","journal-title":"JAMA"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.1016\/S0140-6736(13)62388-0","article-title":"Statins: new American guidelines for prevention of cardiovascular disease","volume":"382","author":"Ridker","year":"2013","journal-title":"Lancet"},{"key":"B29","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1097\/HJH.0000000000001916","article-title":"Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography","volume":"37","author":"Chua","year":"2019","journal-title":"J Hypertens"},{"key":"B30","doi-asserted-by":"publisher","first-page":"6541","DOI":"10.1038\/s41598-020-63603-6","article-title":"Peripapillary microvascular changes in patients with systemic hypertension: an optical coherence tomography angiography study","volume":"10","author":"Shin","year":"2020","journal-title":"Sci Rep"},{"key":"B31","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/APO.0000000000000351","article-title":"Optical coherence tomography angiography in diabetes","volume":"10","author":"Borrelli","year":"2021","journal-title":"Asia Pac J Ophthalmol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1111\/aos.14806","article-title":"Retinal microvasculature impairments in patients with coronary artery disease: an optical coherence tomography angiography study","volume":"100","author":"Zhong","year":"2022","journal-title":"Acta Ophthalmol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"708491","DOI":"10.3389\/fmed.2021.708491","article-title":"Retinal microvasculature changes in patients with coronary total occlusion on optical coherence tomography angiography","volume":"8","author":"Zhong","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"B34","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/s0002-9149(83)80105-2","article-title":"A more meaningful scoring system for determining the severity of coronary heart disease","volume":"51","author":"Gensini","year":"1983","journal-title":"Am J Cardiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"9580","DOI":"10.1038\/s41598-020-66736-w","article-title":"Systemic hypertension associated retinal microvascular changes can be detected with optical coherence tomography angiography","volume":"10","author":"Sun","year":"2020","journal-title":"Sci Rep"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1634816\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T16:04:49Z","timestamp":1757693089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1634816\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":35,"alternative-id":["10.3389\/fcvm.2025.1634816"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1634816","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]},"article-number":"1634816"}}