Cardiovascular risk factors and outcome in patients with retinal vein occlusion

Abstract

The pathogenesis and treatment of retinal vein occlusions (RVO) are largely unclear. Prevalence of cardiovascular risk factors and of thrombophilic abnormalities was evaluated in 117 patients (61 M, 56 F; mean age 51 +/- 13 years) with a history of RVO (62 central, CRVO; 48 branch, BRVO; 7 both) and in 202 age- and sex-matched control subjects. Cardiovascular outcome after a mean 8.2 year follow-up was recorded for 90 patients. Arterial hypertension was significantly more frequent in patients than in controls (64.9 vs. 28.2%; adjusted OR 4.5 95% CI 2.4-7.9; P < 0.0001), as well diabetes mellitus (17.9 vs. 7.9%; P < 0.05). Antithrombin, Protein C, Protein S and homocysteine levels, lupus anticoagulant, anticardiolipin antibodies, FV G1691A and prothrombin G20210A polymorphisms were comparable in the two groups, nor were different according to RVO localization or to the age at event. BRVO patients were significantly older (55 +/- 9 vs. 47 +/- 15 years; P = 0.002) and had higher prevalence of diabetes, overweight and hypertension (29.2 vs. 8.1%; 83.3 vs. 58.1%, 79.2 vs. 56.5%; P always <0.05). In 58/90 (64%) patients for whom clinical follow-up was available, new vascular events were recorded (coronary/cerebral, n = 38); only 22 patients (24%) received long-term antiplatelet agents (mostly aspirin 100 mg/d), with lower, but not statistically significant, prevalence of overall vascular recurrence (45.4 vs. 70.6%, P = 0.06). High rate of vascular recurrence is shown in patients with previous RVO, in which conventional cardiovascular risk factors play a major role, especially in BRVO and in older patients.

Thrombophilia in Patients with Retinal Vein Occlusion: A Retrospective Analysis

“…A recent case-control study revealed the presence of antiphospholipid antibodies as a significant risk factor for developing RVO amongst 80 RVO patients aged 45 years or less, taking into account repeated antibody testing [55]. According to our findings, in a recent case-control study all ACA-positive patients were found amongst CRVO and not BRVO patients [42]. …”

“…The authors acknowledged that this result was probably confounded by the small sample sizes, the lack of age adjustment and the type of patient cohorts found in the reviewed studies [13]. While some subsequent case-control studies more often found MTHFR homozygotes and/or high homocysteine levels amongst RVO cases compared to controls [40,41], others did not [12,42,43,44,45]. …”

Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus

“…The common cardiovascular predisposing systemic risk factors for RVO include hypertension, diabetes mellitus, and dyslipidemia [20,21,22,23,24]. According to a meta-analysis of 21 studies by O'Mahoney et al [24], hypertension and hyperlipidemia were most significantly associated with RVO; the odds ratios (ORs) were 3.5 [95% confidence interval (CI): 2.5-5.1; p < 0.05] and 2.5 (95% CI: 1.7-3.7; p < 0.05), respectively.…”

Management of Retinal Vein Occlusion – Consensus Document

“…This major risk factor is more prevalent in patients with BRVO than in those with CRVO. More than 64% of RVO patients in the age group over 50 years are hypertensive, and it is a predominant finding in recurrent RVO (88%) [26,27]. Likewise, vascular events (cardiovascular, cerebral) are observed more often in patients with preexisting RVO [27].…”