Aims/Purpose: To describe retinal capillary density of normal eyes from patients with metabolic syndrome and to investigate possible associations with main risk factors of cardiovascular disease (smoking, arterial hypertension, dyslipidemia).Methods: This was a prospective cross‐sectional study. We included 214 eyes (clear media, no ocular diseases, no prior surgery or ocular trauma) of 114 patients with metabolic syndrome (median age 54 (49.25, 59.0), male 51 (44.74%), female 63 (55.26%)). Data on ambulatory blood pressure (BP), triglycerides (TG), lipid profile and smoking status were collected. Retinal capillary density at the superficial vascular plexus (SVP) at 6 × 6 mm square of central macular area was measured with a commercial optical coherence tomography angiography OCT‐A (AngioVue®, OptoVue, Framont, CA, USA) system. Linear regression was used to investigate the association of risk factors with capillary density.Results: In the multivariable analysis, older age was associated with sparser retinal vascular density in whole image (β = ‐0.198, p < 0.001), foveal (β = ‐0.264, p = 0.021), perifoveal (β = ‐0.226, p < 0.001) and parafoveal (β = ‐0.153, p = 0.007) areas. Lower capillary density in whole image (β = ‐0.149, p = 0.025) and perifoveal area (β = ‐0.162, p = 0.018) was also associated with higher body mass index in the multivariable analysis. Higher HDL and TG levels were associated with denser retinal capillaries in SVP in whole image (β = 2.064, p = 0.028 and β = 0.847, p = 0.001), perifoveal (β = 2.246, p = 0.023 and β = 0.899, p < 0.001) and parafoveal (β = 2.346, p = 0.047 and β = 0.865, p = 0.024) areas. Systolic and diastolic BP and smoking were not associated with capillary density (p > 0.05).Conclusions: In adults with metabolic syndrome retinal capillary density in SVP was found to be reduced with older age and higher body mass index. Higher HDL and TG concentrations were associated with denser SVP capillaries. The latter results may be the consequence of vasodilatation due to sub‐clinical inflammation.
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