Meta-analysis links RVO, cardiovascular risks

A lower threshold for referral of these patients to primary care may be warranted.

The risk for a cardiovascular event, such as stroke or heart attack, was greater in patients with retinal vein occlusion than in those without, according to a study.

The study is the first large-scale meta-analysis to demonstrate a “fairly strong” association between patients who presented with RVO and subsequent development of cardiovascular events, study co-author Avnish Deobhakta, MD, assistant professor of vitreoretinal surgery at Mount Sinai Icahn School of Medicine, told Ocular Surgery News.

“Eye care specialists who see patients with RVO should strongly consider immediate referral to a primary care physician and possibly specialists like cardiologists or neurologists given the fairly high association between cardiovascular events, such as stroke, and RVO,” Deobhakta said.

The systematic review and meta-analysis of 15 observational studies included 60,069 patients with RVO and 414,397 without. Each study had a Newcastle-Ottawa scale score of 6 or greater, indicating moderate to high quality.

Patients were required to have an average follow-up of 1 year or more.

Patients with RVO had a 45% increased risk for developing a stroke, and incidence of stroke was one of the more highly associated events with RVO in the analysis, Deobhakta said.

“While the reasons are not entirely clear, it is likely that patients with RVO have underlying, and often unknown at the time, cardiovascular disease. Given that the neurological system includes the retina, our hypothesis would be that having an adverse vascular event in the retina already predisposes other neurological organs, such as the brain, to having additional vascular events as well,” Deobhakta said.

Patients with RVO were associated with an increased risk for myocardial infarction (RR = 1.26; 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). However, RVO patients were not at an increased risk for cardiovascular mortality.

It should be incumbent on ophthalmologists to connect a patient with RVO to an appropriate physician as quickly as possible based on the outcomes of this study, Deobhakta said.

“Our study demonstrates incredibly well the importance of collaboration and co-management with our non-ophthalmologist medical colleagues in order to prevent adverse systemic outcomes. Of note, it really does show that eye care specialists often see sentinel conditions, in this case, a vascular event in vivo, frequently before any other systemic symptoms are noted,” he said. “Our study may also suggest that ophthalmologists should at least consider a lower threshold for referral to a cardiologist or a neurologist. In other words, it might be necessary to engage with the primary care physician more closely for such referrals than what current practice patterns suggest.” – by Robert Linnehan

Disclosure: Deobhakta reports no relevant financial disclosures.

The risk for a cardiovascular event, such as stroke or heart attack, was greater in patients with retinal vein occlusion than in those without, according to a study.

The study is the first large-scale meta-analysis to demonstrate a “fairly strong” association between patients who presented with RVO and subsequent development of cardiovascular events, study co-author Avnish Deobhakta, MD, assistant professor of vitreoretinal surgery at Mount Sinai Icahn School of Medicine, told Ocular Surgery News.

“Eye care specialists who see patients with RVO should strongly consider immediate referral to a primary care physician and possibly specialists like cardiologists or neurologists given the fairly high association between cardiovascular events, such as stroke, and RVO,” Deobhakta said.

The systematic review and meta-analysis of 15 observational studies included 60,069 patients with RVO and 414,397 without. Each study had a Newcastle-Ottawa scale score of 6 or greater, indicating moderate to high quality.

Patients were required to have an average follow-up of 1 year or more.

Patients with RVO had a 45% increased risk for developing a stroke, and incidence of stroke was one of the more highly associated events with RVO in the analysis, Deobhakta said.

“While the reasons are not entirely clear, it is likely that patients with RVO have underlying, and often unknown at the time, cardiovascular disease. Given that the neurological system includes the retina, our hypothesis would be that having an adverse vascular event in the retina already predisposes other neurological organs, such as the brain, to having additional vascular events as well,” Deobhakta said.

Patients with RVO were associated with an increased risk for myocardial infarction (RR = 1.26; 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). However, RVO patients were not at an increased risk for cardiovascular mortality.

It should be incumbent on ophthalmologists to connect a patient with RVO to an appropriate physician as quickly as possible based on the outcomes of this study, Deobhakta said.

“Our study demonstrates incredibly well the importance of collaboration and co-management with our non-ophthalmologist medical colleagues in order to prevent adverse systemic outcomes. Of note, it really does show that eye care specialists often see sentinel conditions, in this case, a vascular event in vivo, frequently before any other systemic symptoms are noted,” he said. “Our study may also suggest that ophthalmologists should at least consider a lower threshold for referral to a cardiologist or a neurologist. In other words, it might be necessary to engage with the primary care physician more closely for such referrals than what current practice patterns suggest.” – by Robert Linnehan

Disclosure: Deobhakta reports no relevant financial disclosures.