Retinal Vein Occlusion Diagnosis Linked to Higher Risk of Cardiovascular Disease

New findings from a nationwide cohort in Denmark suggest patients with retinal vein occlusion (RVO) had an increased risk of incident cardiovascular disease (CVD), compared with unexposed individuals in the same cohort.

Moreover, the research found an increased risk of all-cause mortality in patients with RVO overall and in subgroups of both branch and central RVO, when diagnosed after the introduction of angiostatic therapy in 2011.

“In this 20-year nationwide cohort study, patients with RVO had 13%–23% higher risks to develop overall, ischemic and non ischemic CVD as compared with non-exposed controls,” wrote study author Katrine Hartmund Frederiksen, Department of Ophthalmology, Odense University Hospital.

As treatment options for RVO were limited before the introduction of intravitreal vascular endothelial growth factor (VEGF) inhibition, previous reports of increased risk of CVD and mortality in patients with RVO may not reflect the current population, according to the investigators.

Thus, the team of investigators set out to evaluate the association between RVO and CVD and all-cause mortality, any potential differences in the risk between BRVO and CRVO, and to compare these associations in patients with RVO referred before and after 2011.

The study population was identified from the Danish national registers and individuals were required to be or become 40 years of age between January 1998 and December 2017, with follow-up until December 2018.

Investigators used a multivariate Cox proportional hazards model to compare CVD hazards of individuals with RVO to those without RVO, estimating hazard ratios (HRs) with 95% confidence intervals (CI).

A total of 4,194,781 unique individuals met inclusion criteria and were included in the overall cohort. The patients with RVO (n = 15,665) had a median age of 71.8 years old at time of exposure and 50.7% were women.

Data show RVO exposure was associated with increased risk of incident CVD (adjusted HR, 1.13; 95% CI, 1.09 - 1.17). However, it was not associated with mortality (adjusted HR, 1.01; 95% CI, 0.98 - 1.03).

Moreover, the risk of ischemic CVD and nonischemic CVD was higher in those exposed to RVO, most often in non-ischemic CVD (adjusted HR, 1.23; 95% CI, 1.15 - 1.33). Similar risks of CVD were found for patients with BRVO and CRVO (adjusted HRs, 1.14; 95% CI, 1.03 to 1.25 and 1.12, 95% CI, 1.00 - 1.25, respectively).

Additionally, investigators observed an increased risk of all-cause mortality in individuals with RVO referred after 2011 (adjusted HR before 2011, 0.97; 95% CI, 0.94 - 1.00 vs after 2011, HR 1.11; 95% CI, 1.06 - 1.16).

In the conclusion, Frederiksen noted the findings which show the mortality risk after 2011 is higher in BRVO, but lower in CRVO.

“This empowers the interpretation that difference in mortality prior to and after 2011 was a result of changed referral practice and possibly difference in severity of comorbid conditions in patients, rather than the treatment itself, since both subgroups of RVO have been treated with anti-VEGF,” Frederiksen said.

The study, “Cardiovascular morbidity and all-cause mortality in patients with retinal vein occlusion: a Danish nationwide cohort study,” was published in the British Journal of Ophthalmology.