Development and validation of a deep learning algorithm using fundus photographs to predict 10-year risk of ischemic cardiovascular diseases among Chinese population

Background Ischemic cardiovascular diseases (ICVD) risk predict models are valuable but limited by its requirement for multidimensional medical information including that from blood drawing. A convenient and affordable alternative is in demand. Objectives To develop and validate a deep learning algorithm to predict 10-year ICVD risk using retinal fundus photographs in Chinese population. Methods We firstly labeled fundus photographs with natural logarithms of ICVD risk estimated by a previously validated 10-year Chinese ICVD risk prediction model for 390,947 adults randomly selected (95%) from a health checkup dataset. An algorithm using convolutional neural network was then developed to predict the estimated 10-year ICVD risk by fundus images. The algorithm was validated using both internal dataset (the other 5%) and external dataset from an independent source (sample size = 1,309). Adjusted R 2 and area under the receiver operating characteristic curve (AUC) were used to evaluate the goodness of fit. Results The adjusted R 2 between natural logarithms of the predicted and calculated ICVD risks was 0.876 and 0.638 in the internal and external validations, respectively. For detecting ICVD risk ≥ 5% and ≥ 7.5%, the algorithm achieved an AUC of 0.971 (95% CI: 0.967–0.975) and 0.976 (95% CI: 0.973–0.980) in internal validation, and 0.859 (95% CI: 0.822–0.895) and 0.876 (95% CI: 0.816–0.837) in external validation. Conclusions The deep learning algorithm developed in the study using fundus photographs to predict 10-year ICVD risk in Chinese population had fairly good capability in predicting the risk and may have values to be widely promoted considering its advances in easy use and lower cost. Further studies with long term follow up are warranted.