Retinal Vein Occlusion and Vascular Mortality: Pooled Data Analysis of 2 Population-Based Cohorts

doi:10.1016/j.ophtha.2006.06.061

Ophthalmology

Volume 114, Issue 3, March 2007, Pages 520-524

https://doi.org/10.1016/j.ophtha.2006.06.061 Get rights and content

Purpose

To assess the association of retinal vein occlusion (RVO) with cardiovascular and cerebrovascular mortality.

Design

Pooled data from 2 population-based cohort studies.

Participants

At baseline, the Beaver Dam Eye Study (BDES) examined 4926 persons aged 43 to 86 years (from 1988–1990) and the Blue Mountains Eye Study (BMES) examined 3654 persons aged 49 to 97 years (from 1992 to 1994).

Methods

Retinal vein occlusion was assessed from retinal photographs. Vascular deaths were determined using either death certificates (BDES) or the Australian National Death Index (BMES). Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Main Outcome Measure

Vascular (cardiovascular and cerebrovascular) mortality was determined.

Results

Of 8384 baseline participants, 96 (1.14%) had RVO at baseline (BDES, n = 38; BMES, n = 58). Over 12 years, 1312 (15.7%) died of cardiovascular-related conditions and 341 (4.1%) died of cerebrovascular-related conditions. Age-standardized vascular mortality rates were 26.0% and 5.3%, respectively, in persons with RVO and 17.1% and 4.5%, respectively, in those without RVO. After adjusting for age, gender, body mass index, hypertension, diabetes, smoking, glaucoma, and study site, RVO was not associated with cardiovascular-related mortality (HR, 1.2; 95% CI, 0.8–1.8) or cerebrovascular-related mortality (HR, 0.9; 95% CI, 0.4–2.1) among participants of all ages. However, in persons aged less than 70 years, baseline RVO was associated with higher cardiovascular mortality (combined BDES and BMES: HR, 2.5; 95% CI, 1.2–5.2; BDES: HR, 2.5; 95% CI, 0.9–6.9; BMES: HR, 2.1; 95% CI, 0.7–6.8).

Conclusions

Retinal vein occlusion in persons aged 43 to 69 years may signal a doubling of the risk of cardiovascular mortality.

Section snippets

Patients and Methods

The BDES and BMES are 2 population-based cohort studies of vision and common eye diseases in predominantly white populations examined using similar protocols. Both were approved by the human research ethics committees in their respective institutions and were conducted adhering to tenets of the Declaration of Helsinki. The BDES examined 4926 of 5924 eligible residents aged 43 to 86 years (83.1% response) from 1988 through 1990 in Beaver Dam, Wisconsin. The BMES examined 3654 of 4433 eligible

Results

Table 1 shows age- and gender-specific prevalence of RVO at baseline, plus baseline characteristics by RVO status in the 2 populations. Age-specific RVO prevalence was nearly double in the BMES compared with the BDES. Participants in both studies with baseline RVO were significantly older and were more likely to have hypertension. In the BDES, participants with RVO also were more likely to have diabetes. In the BMES, participants with RVO were more likely to report a history of angina or

Discussion

In this pooled data analysis of 2 white population-based cohorts, we found that in persons aged 43 to 69 years, the presence of RVO was associated with a 2-fold higher risk of cardiovascular mortality. Also in men, presence of RVO was associated with a nonsignificant, 2-fold higher risk of cerebrovascular mortality for all ages. These findings support an association between RVO and vascular mortality, suggested by previous clinical studies.7, 8, 9 In our study population, glaucoma patients

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Cited by (150)

Evaluation of the ambulatory blood pressure monitoring in patients with retinal vein occlusion
2023, Medicina Clinica
La hipertensión arterial (HTA) es el principal factor de riesgo para el desarrollo de la obstrucción venosa retiniana (OVR).
Analizar el perfil hipertensivo con monitorización ambulatoria de la presión arterial (MAPA) en pacientes con una OVR.
Estudio con MAPA en 66 pacientes, 33 con OVR pertenecientes a una cohorte con esta enfermedad y 33 controles sin OVR ajustados por edad y sexo.
Los pacientes con OVR tuvieron, respecto a los controles, cifras nocturnas elevadas de PAS 130 mmHg (21) vs.119 mmHg (11); p = 0,01 y PAD 73 mmHg (11) vs. 65 mmHg (9); p = 0,002. Además, presentaron menor descenso del porcentaje de Dipping ratio 6,0% (10,4) vs. 12,3% (6,3); p = 0,005.
Los pacientes con OVR tienen un perfil hipertensivo nocturno desfavorable. El reconocimiento de este hecho puede ayudar a optimizar el tratamiento.
Arterial hypertension (AHT) is the main risk factor for the development of retinal vein occlusion (RVO).
To analyze the hypertensive profile with ambulatory blood pressure monitoring (ABPM) in patients with RVO.
Retrospective and observational study of 66 patients with ABPM, 33 with retinal vein occlusion from a cohort of these disease and 33 controls without RVO, adjusted for age and sex.
Compared to controls, patients with RVO had elevated nocturnal values of SBP 130 mmHg (21) vs. 119 mmHg (11); P=.01 and DBP 73 mmHg (11) vs. 65 mmHg (9); P=.002. In addition, they presented a lower decrease in the Dipping ratio percentage 6.0% (10.4) vs. 12.3% (6.3); P=.005.
Patients with RVO have an unfavorable nocturnal hypertensive profile. Recognition of this fact can help optimize their treatment.
Retinal vein occlusion in the general population after COVID-19 vaccination and infection
2023, Medicina Clinica
Retinal vein occlusion (RVO) is mostly a consequence of vascular risk factors (VRF). COVID-19 vaccines have been related to vascular and thrombotic events (VTE).
To assess the RVO incidence in the general population in our health area and the possible relation with COVID-19 infection and vaccination.
Demographic features, classic VRF, thrombophilia data, COVID-19 status, and Framingham risk score were collected prospectively.
472 consecutive patients studied over 13 years with RVO were included (Valdecilla Cohort). Classic VRFs were present in 90%, antiphospholipid syndrome in 12.3%, and genetic thrombophilia in 13.5%. Ninety-one percent of RVO patients were vaccinated and 6.8% suffered COVID-19 infection. In the cohort, no patient had a new RVO after vaccination or infection. In the general population, 20 subjects had RVO after receiving the vaccine (0.006%). Overall, 8 cases occurred in the first-month post-vaccination and 12 after 30 days. In the early and late groups, there are 3 and 4 patients respectively, with a low-intermediate risk Framingham score. Twenty-nine patients in the cohort suffered SARS-CoV-2 infection, twenty-seven of them had RVO before infection. Two patients with low-risk Framingham scores had RVO after infection, one of them early (<1 month).
Vaccination and COVID-19 might be involved in the development of RVO in some cases, mainly in patients without VRF, thrombophilia, or chronic inflammatory conditions and with a lower Framingham score, especially in the first month after vaccination or infection.
La oclusión venosa retiniana (OVR) es principalmente una consecuencia de los factores de riesgo vascular (FRV). Las vacunas contra la COVID-19 se han relacionado con eventos vasculares y trombóticos (EVT).
Evaluar la incidencia de OVR en la población general de nuestra área de salud y su posible relación con la COVID-19 y la vacunación.
Se recopilaron prospectivamente las características demográficas, FRV clásicos, datos sobre trombofilia, padecimiento de la COVID-19 y puntuación de riesgo de Framingham.
Se incluyeron 472 pacientes consecutivos con OVR, estudiados durante 13 años (Cohorte Valdecilla). Los FRV clásicos estaban presentes en el 90%, el síndrome antifosfolípido en el 12,3% y la trombofilia genética en el 13,5% de los casos. El 91% de los pacientes con OVR recibieron la vacuna frente a la COVID-19 y el 6.8% sufrió la infección. En la cohorte, ningún paciente tuvo una nueva OVR después de la vacunación o de la infección. En la población general, 20 sujetos presentaron OVR después de recibir la vacuna (0,006%). En general, 8 casos ocurrieron en el primer mes después de la vacunación y 12 después de 30 días. En los grupos precoz y tardío, 3 y 4 pacientes respectivamente, presentaban una puntuación de Framingham de riesgo bajo o intermedio. Veintinueve pacientes de la cohorte sufrieron infección por SARS-CoV-2 y 27 de ellos tuvieron una OVR antes de ésta. Dos pacientes con puntuaciones de Framingham de bajo riesgo presentaron una OVR después de la infección, uno de ellos precozmente (<1 mes).
La vacunación y la COVID-19 podrían estar involucradas en el desarrollo de OVR en algunos casos, principalmente en pacientes sin FRV, trombofilia o procesos inflamatorios crónicos y con una puntuación de Framingham más baja, especialmente en el primer mes después de la vacunación o de la infección.
A Datasheet for the INSIGHT University Hospitals Birmingham Retinal Vein Occlusion Data Set
2023, Ophthalmology Science
Retinal vein occlusion (RVO) is the second leading cause of visual loss due to retinal disease. Retinal vein occlusion increases the risk of cardiovascular mortality and the risk of stroke. This article describes the data contained within the INSIGHT eye health data set for RVO and cardiovascular disease.
Data set descriptor for routinely collected eye and systemic disease data.
All people who had suffered an RVO aged ≥ 18 years old, attending the Ophthalmology Clinic at Queen Elizabeth Hospital, University Hospitals Birmingham (UHB) National Health Service (NHS) Trust were included.
The INSIGHT Health Data Research Hub for Eye Health is an NHS-led ophthalmic bioresource. It provides researchers with safe access to anonymized routinely collected data from contributing NHS hospitals to advance research for patient benefit. This report describes the INSIGHT UHB RVO and major adverse cardiovascular events data set, a data set of ophthalmology and systemic data derived from the United Kingdom’s largest acute care trust.
This data set consists of routinely collected data from the hospital’s electronic patient records. The data set primarily includes structured data (relating to their hospital eye care and any cardiovascular data held for the individual) and OCT ocular images. Further details regarding the available data points are available in the supplementary information.
At the time point of this analysis (September 30, 2022) the data set was composed of clinical data from 1521 patients, from Medisoft records inception. The data set includes 2196 occurrences of RVO affecting 2026 eyes, longitudinal eye follow-up clinical parameters, over 6217 eye-related procedures, and 982 encountered complications. The data set contains information on 2534 major adverse cardiovascular event occurrences, their subtype, number experienced per patient, and chronological relation to RVO event. Longitudinal follow-up data including laboratory results, regular medications, and all-cause mortality are also available within the data set.
This data set descriptor article summarizes the data set contents, the process of its curation, and potential uses. The data set is available through the structured application process that ensures research studies are for patient benefit. Further information regarding the data repository and contact details can be found at https://www.insight.hdrhub.org/.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Adjusted global antiphospholipid syndrome score (aGAPSS) is useful to predict relapses in patients with retinal vein occlusion
2023, Thrombosis Research
A significant proportion of patients with retinal vein occlusion (RVO) are antiphospholipid antibodies (aPL) carriers. Relapsing disease occurs in nearly 10 % of cases and the role of aPL has not been established. The adjusted global antiphospholipid syndrome score (aGAPSS) was developed to assess the risk of clinical events in aPL carriers and its role in the management of RVO patients is unknown.
To analyze the values of aGAPSS in a large cohort of patients with RVO and population-based controls, and to assess its usefulness to predict RVO relapses.
Case-control study of RVO patients and population-based controls of similar age and sex. We have assessed and compared the aPL profile and the aGAPSS score in patients with and without relapsing disease and controls.
Four-hundred and seventy-two RVO patients and 346 controls were included. Fifty-seven RVO patients had antiphospholipid syndrome (RVO-APS). Of them, 75.4 % had a high-risk profile compared to 3 % in controls (p = 0.0001). The median aGAPSS values were 8 [7–13], 3 [1–4], and 3 [0–4], in RVO-APS, RVO no-APS, and controls. Nineteen patients had had a recurrence of RVO before inclusion and 8 during the follow-up. APS was more prevalent in relapsing patients. In the adjusted multivariable regression model, the best predictor for RVO recurrence during the follow-up was an aGAPSS score ≥6 (OR 5.5, CI95% 1.3–23.7; p = 0.023).
In patients with RVO, once the control of vascular risk factors has been optimized, the aGAPSS might help to identify those at risk of relapsing disease.
Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies
2022, Archivos de la Sociedad Espanola de Oftalmologia
La oclusión venosa retiniana (OVR) se ha relacionado con factores de riesgo vascular y trombofilia.
Se trata de un estudio de cohorte prospectivo de todos los pacientes diagnosticados de OVR y remitidos a una clínica de medicina interna de un hospital universitario terciario durante un período de 10 años. Se analizaron variables clínicas, de laboratorio y ecográficas de troncos supraaórticos y se compararon según la edad.
Se incluyeron unos 309 pacientes diagnosticados de OVR, 25 de ellos menores de 50 años. La prevalencia de hipertensión arterial, dislipidemia, diabetes mellitus, hiperhomocisteinemia y placa carotídea fue significativamente mayor en pacientes > 50 años que en los menores. Sin embargo, la prevalencia de trombofilia hereditaria fue mayor en el grupo más joven (32 vs. 11,4%; p = 0,005). Se observaron enfermedades poco frecuentes relacionadas con la OVR como hepatitis C, talasemia menor, enfermedad de Lyme, vasculitis y perlebitis en pacientes jóvenes sin factores de riesgo vascular.
Sugerimos realizar un estudio genético de trombofilia en pacientes con OVR menores de 50 años, siendo siempre recomendable un control exhaustivo de los factores de riesgo vascular en todos los pacientes con OVR. Además, sugerimos tener en cuenta las enfermedades poco frecuentes relacionadas con la OVR, especialmente en pacientes jóvenes sin factores de riesgo vascular.
Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia.
This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age.
Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients >50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0 vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors.
We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors.
Novel Association between Opioid Use and Increased Risk of Retinal Vein Occlusion Using the National Institutes of Health All of Us Research Program
2022, Ophthalmology Science
To assess for risk factors for retinal vein occlusion (RVO) among participants in the National Institutes of Health All of Us database, particularly social risk factors that have not been well studied, including substance use.
Retrospective, case-control study.
Data were extracted for 380 adult participants with branch retinal vein occlusion (BRVO), 311 adult participants with central retinal vein occlusion (CRVO), and 1520 controls sampled among 311 640 adult participants in the All of Us database.
Data were extracted regarding demographics, comorbidities, income, housing, insurance, and substance use. Opioid use was defined by relevant diagnosis and prescription codes, with prescription use > 30 days. Controls were sampled at a 4:1 control to case ratio from a pool of individuals aged > 18 years without a diagnosis of RVO and proportionally matched to the demographic distribution of the 2019 U.S. census. Multivariable logistic regression identified medical and social determinants significantly associated with BRVO or CRVO. Statistical significance was defined as P < 0.05.
Development of BRVO or CRVO based on diagnosis codes.
Among patients with BRVO, the mean (standard deviation) age was 70.1 (10.5) years. The majority (53.7%) were female. Cases were diverse; 23.7% identified as Black, and 18.4% identified as Hispanic or Latino. Medical risk factors including glaucoma (odds ratio [OR], 3.29; 95% confidence interval [CI], 2.22–4.90; P < 0.001), hypertension (OR, 2.15; 95% CI, 1.49–3.11; P < 0.001), and diabetes mellitus (OR, 1.68; 95% CI, 1.18–2.38; P = 0.004) were re-demonstrated to be associated with BRVO. Black race (OR, 2.64; 95% CI, 1.22–6.05; P = 0.017) was found to be associated with increased risk of BRVO. Past marijuana use (OR, 0.68; 95% CI, 0.50–0.92; P = 0.013) was associated with decreased risk of BRVO; however, opioid use (OR, 1.98; 95% CI, 1.41–2.78; P < 0.001) was associated with a significantly increased risk of BRVO. Similar associations were found for CRVO.
Understanding RVO risk factors is important for primary prevention and improvement in visual outcomes. This study capitalizes on the diversity and scale of a novel nationwide database to elucidate a previously uncharacterized association between RVO and opioid use.

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Manuscript no. 2006-263.

Supported by the Australian National Health & Medical Research Council, Canberra, Australia (grant nos.: 153948, 302068, 974159, 211069); National Institutes of Health, Bethesda, Maryland (grant no.: EY 06594 [RK, BEKK]); and Research to Prevent Blindness, Inc., New York, New York (RK, BEKK).

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Original ArticleRetinal Vein Occlusion and Vascular Mortality: Pooled Data Analysis of 2 Population-Based Cohorts

Purpose

Design

Participants

Methods

Main Outcome Measure

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Aust N Z J Public Health

Aust N Z J Public Health

Ophthalmology

Surv Ophthalmol

Exp Mol Pathol

Am J Ophthalmol

Prevalence and associations of retinal vein occlusion in Australia: the Blue Mountains Eye Study

Arch Ophthalmol

The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study

Trans Am Ophthalmol Soc

Original Article
Retinal Vein Occlusion and Vascular Mortality: Pooled Data Analysis of 2 Population-Based Cohorts