Retinal BioAge is associated with indicators of cardiovascular-kidney-metabolic syndrome in UK and US populations.

Accelerated biological aging, as well as cardiovascular, kidney, and metabolic (CKM) diseases, contribute to shortened healthspan. We studied a deep-learning model, retinal BioAge, and multiple indicators of CKM syndrome in participants from UK Biobank and the US-based EyePACS dataset. Retinal BioAge was trained on 77,887 retinal images and then used to analyze separate retinal images from UK Biobank (10,976) and EyePACS (19,856). In both datasets, CKM biomarker profiles were significantly worse for the top vs. bottom quartiles of BioAgeGap (retinal BioAge-chronological age), including measures of blood pressure, kidney function, adiposity, and glycemia. The top BioAgeGap quartile also had a significantly higher prevalence of clinical CKM indicators, including hypertension, kidney disease, and diabetes (UK Biobank) or suboptimally controlled diabetes (EyePACS). Thus, analysis of retinal images for accelerated biological aging may provide opportunistic screening to help identify individuals who could benefit from formal CKM assessment, potentially contributing to earlier detection and management of CKM syndrome.