Ocular manifestations of systemic cardiovascular diseases: a systematic review

Cardiovascular diseases are among the leading causes of morbidity and mortality worldwide, and increasing evidence suggests that ocular manifestations, particularly retinal changes, reflect systemic vascular involvement. The retina allows direct and noninvasive visualization of the microcirculation and may serve as an accessible biomarker of cardiovascular health. This study aimed to systematically review the ocular manifestations associated with major cardiovascular diseases and to correlate retinal findings with systemic cardiovascular risk. A systematic literature review was conducted using the PubMed/MEDLINE database, including studies published in English, available in full text, without temporal restriction. Observational studies, systematic reviews, meta-analyses, and relevant narrative reviews addressing ocular, especially retinal, manifestations in adult patients with cardiovascular diseases were included. The findings indicate that hypertensive retinopathy, changes in retinal vessel caliber, retinal vascular occlusions, and microvascular alterations detected by advanced imaging techniques such as optical coherence tomography angiography are consistently associated with increased cardiovascular risk, including coronary artery disease, stroke, and thromboembolic events. These manifestations reflect shared pathophysiological mechanisms such as endothelial dysfunction, inflammation, and vascular remodeling. In conclusion, retinal alterations represent important markers of systemic cardiovascular disease, and their systematic assessment may contribute to early risk stratification, preventive strategies, and integrated clinical management across ophthalmology and cardiovascular care.