RVO Risk: CVD and Hypertension

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Retinal vein occlusion (RVO) is associated with increased risks for stroke, myocardial infarction (MI), and other cardiovascular events, conferring levels of risk beyond traditional factors, a meta-analysis of 15 longitu­dinal cohort studies has concluded.¹

Meanwhile, a separate meta-analysis has found that hypertension doubles the risk of RVO, making it the strongest risk factor for development of an occluded retinal vein.²

CVD in general. Researchers in New York and Ha­waii evaluated observational data on 474,466 subjects, 60,069 of whom (12.7%) had RVO. The results showed that the patients with RVO were at greater risk of cardiovascular disease (CVD) and all-cause mortality than their healthy counterparts. Specifically, they had a 45% increased risk of stroke, 26% increased risk of MI, 53% increased risk of heart failure, 26% increased risk of peripheral arterial disease, and 36% increased risk of all-cause mortality.¹

The added risks were statistically significant despite adjustment for confounding factors such as age, gender, hypertension, diabetes, and other medical comorbidities, said coauthor Avnish Deobhakta, MD, at the New York Eye and Ear Infirmary of Mount Sinai in New York City.

Previous case series and longitudinal cohort studies that examined the association of RVO with stroke or MI produced inconsistent conclusions, Dr. Deobhakta said. He said he believes the current study settles the issue. “I think the evidence is pretty compelling that RVO is a sentinel event for cardiovascular risks,” Dr. Deobhakta said. “I look at it now as a canary in the coal mine for these other systemic kinds of morbidity-inducing or even life-threatening health risks.”

Hypertension in particular. Researchers in the United Kingdom and China assessed the impact of nine risk fac­tors on the development of any type of RVO. Hyperten­sion proved to be the strongest risk factor, followed by heart attack history, stroke history, and elevated levels of total cholesterol and creatinine.²

Overall, the researchers estimated, the global preva­lence of any type of RVO was 0.77% in 2015, equivalent to 23.38 million cases of branch RVO and 6.7 million cases of CRVO. That was up from 16.4 million total cases worldwide of any type of RVO in 2008.

Urgent issue. Once RVO is diagnosed, Dr. Deobhakta suggested, the ophthalmologist should consider urgent­ly referring the patient to a primary care physician for intensive medical management of the person’s cardio­vascular risks—and, possibly, should add a strong recommendation for prompt evaluation and follow-up by a cardiologist or neurologist.

“A retinal vein occlusion, by definition, is when a really small vessel in the eye is blocked or there’s some kind of patholo­gy with it. Well, if a really small vessel in the eye is showing that it can be affected in this way, then other vessels can have that kind of problem” as well, Dr. Deobhak­ta said. “And if we can prevent a stroke or other cardiovascular complication by sending these patients to the right specialists, or getting the right imaging tests, then that would be recommend­ed.”

—Linda Roach

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1 Wu CY et al. Retina. 2019;39(9):1635-1645.

2 Song P et al. J Glob Health. 2019;9(1):010427.

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Relevant financial disclosures—Dr. Deobhakta: Alimera Sciences: C; Allergan: C

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