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ASSOCIATION OF RETINAL VEIN OCCLUSION WITH CARDIOVASCULAR EVENTS AND MORTALITY

A Systematic Review and Meta-analysis

Wu, Chris Y. MD*; Riangwiwat, Tanawan MD; Limpruttidham, Nath MD, MPH; Rattanawong, Pattara MD; Rosen, Richard B. MD*,‡; Deobhakta, Avnish MD*,‡

doi: 10.1097/IAE.0000000000002472
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Purpose: Previous studies examining the association of retinal vein occlusion (RVO) and cardiovascular events have been inconsistent and have mostly focused on stroke and myocardial infarction. The goal of this study is to use meta-analysis to examine the available evidence examining the association of RVO with incident cardiovascular events and mortality.

Methods: Systematic review and meta-analysis of all longitudinal cohort studies published in PubMed, Embase, and the Cochrane Library from inception to April 7, 2018, that evaluated the association of baseline RVO and incident cardiovascular events and/or mortality, that provided multivariate-adjusted risk estimates with 95% confidence intervals (95% CIs), and that had average follow-up ≥1 year. The Newcastle–Ottawa scale was used to assess study quality. Multivariate-adjusted risk estimates with 95% CI along with study characteristics were extracted from each study, and pooled risk ratios (RRs) with 95% CI were generated using a random-effects model with inverse-variance weighting to account for heterogeneity. Main outcomes were incident stroke (fatal or nonfatal), myocardial infarction, heart failure, peripheral arterial disease, all-cause mortality, and cardiovascular mortality.

Results: Fifteen cohort studies with a total of 474,466 patients (60,069 with RVO and 414,397 without RVO) were included. Each study had Newcastle–Ottawa scale score ≥6, indicating moderate-to-high quality. Retinal vein occlusion was associated with increased risk of stroke (RR = 1.45; 95% CI, 1.31–1.60), myocardial infarction (RR = 1.26; 95% CI, 1.17–1.37), heart failure (RR = 1.53; 95% CI, 1.22–1.92), peripheral arterial disease (RR = 1.26; 95% CI, 1.09–1.46), and all-cause mortality (RR = 1.36; 95% CI, 1.02–1.81), but was not associated with increased risk of cardiovascular mortality (RR = 1.78; 95% CI, 0.70–4.48).

Conclusion: This review suggests patients with RVO have an increased risk of cardiovascular events and all-cause mortality. More studies are needed to determine the highest risk periods for cardiovascular events and mortality after RVO and whether immediate cardiovascular evaluation and intervention will improve outcomes.

In this systematic review and meta-analysis of observational studies, patients with retinal vein occlusions had an increased risk of stroke, myocardial infarction, heart failure, peripheral arterial disease, and all-cause mortality compared to patients without retinal vein occlusion. More studies are needed to determine the highest risk periods for cardiovascular events and mortality after retinal vein occlusion and whether immediate cardiovascular evaluation and intervention will improve outcomes.

*Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York;

Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii; and

Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.

Reprint requests: Avnish Deobhakta, MD, Department of Ophthalmology, New York Eye and Ear Infirmary, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, 310 East 14th Street, New York, NY 10003; e-mail: adeobhakta@nyee.edu

None of the authors has any financial/conflicting interests to disclose.

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© 2019 by Ophthalmic Communications Society, Inc.