A higher than normal risk was found in people without diabetes, a disease that is known to boost the risk of coronary artery disease, the findings show.
The Australian researchers assessed the presence and severity of retinal disease (retinopathy) among almost 3000 adults, using retinal photos. Two hundred of these participants had been diagnosed with diabetes.
In all, 57 of those with diabetes had retinopathy, a prevalence of just under 29%. One in 10 of those without diabetes also had it.
The research team then tracked the number of people dying from coronary heart disease over a period of 12 years, during which time the death toll was 353.
People with diabetes and moderate retinopathy were more than six times as likely to die of coronary heart disease as those without retinopathy, after adjusting for other influential factors.
And those without diabetes were 50% more likely to die of coronary heart disease if they had retinopathy, equivalent to the same level of risk conferred by a diagnosis of diabetes alone.
This finding is important, say the researchers: one in 10 of the population without diabetes has retinal disease, which can be detected by proper eye examination.
The links between retinopathy and coronary heart disease are not clear, say the authors. Retinopathy may signal generalised microvascular disease and inflammation, leading to the artery hardening characteristic of ischaemic heart disease, they suggest.