Retinal Vein Occlusion Associated With Stroke

Lara C. Pullen, PhD

April 02, 2015

Retinal vein occlusion (RVO) is significantly associated with stroke development, according to a recent study. Although the investigators adjusted for potential confounders, they acknowledge that the findings are still limited.

Tyler Hyungtaek Rim, MD, MBA, from Yonsei University College of Medicine in Seoul, South Korea, and colleagues published the results of their nationwide, population-based, 9-year longitudinal study online February 25 in Ophthalmology. They examined 6105 sociodemographically matched subjects who were extracted from a national database of 1,025,340 patients.

The study focused on 1031 patients with RVO and 5074 control patients. Diagnoses of RV, stroke, and other comorbidities were performed on the basis of Korean Classification of Diseases codes.

In the RVO group, 16.8% of patients developed stroke compared with 10.7% of patients in the control group (P < .001). Patients in the RVO group were also more likely to experience hypertension (P < .001), diabetes mellitus (P < .001), and chronic kidney disease (P < .001) than patients in the control group.

When the researchers adjusted for age, sex, residential area, household income, and comorbidities including hypertension, diabetes mellitus, and chronic kidney disease, RVO was associated with an increased risk of developing stroke (hazard ratio, 1.48; 95% confidence interval, 1.24 - 1.76).

The effect size of the hazard ratio was largest among individuals younger than 50 years (hazard ratio, 2.69) compared with individuals aged 50 to 59 years (hazard ratio, 1.33) and individuals aged 70 years and older (hazard ratio, 1.46).

The investigators note that vein occlusion is not a single disease. Strokes can be either ischemic (occlusion of a blood vessel) or hemorrhagic (rupture of a blood vessel). When the investigators evaluated the two types of strokes separately, patients with RVO were at increased risk for both ischemic (hazard ratio, 1.51; 95% confidence interval, 1.24 - 1.84) and hemorrhagic (hazard ratio, 1.30; 95% confidence interval, 0.83 - 2.05) stroke, although the result was not significant for hemorrhagic stroke.

Hypertension, diabetes mellitus, chronic kidney disease, and increasing age were all associated with a higher risk for both types of stroke.

Vascular disease in vascular beds such as the retina has been previously associated with an increased risk for stroke. Thus, the current study builds on previously published clinical and epidemiologic studies. Tongalp H. Tezel, MD, from the Department of Ophthalmology, Columbia University in New York City, did not believe the study was particularly original. "I am not very surprised with the results," he explained to Medscape Medical News.

Paul Nyquist, MD, from the Neurocritical Care Unit at Johns Hopkins Hospital in Baltimore, Maryland, agreed. "This has been seen in small vessel disease in the heart and kidney as well as the eyes. This confirms that small to medium-sized vessel disease in the eye is associated with increased stroke risk in the brain. It is not unexpected, but it is a first, and was well done in a single population with large numbers and long-term follow-up," he explained to Medscape Medical News.

Hypertension is the most prevalent risk factor in young adults experiencing stroke. As patients age, stroke becomes more common. The investigators found that hypertension, diabetes mellitus, and chronic kidney disease were also associated with an increased risk of developing stroke.

The high prevalence of stroke in an aging population undermined the study, according to Dr Tezel, and the current study was both poorly designed and not powered to make strong conclusions about the relationship between RVO and stroke.

The authors, Dr Tezel, and Dr Nyquist have disclosed no relevant financial relationships.

Ophthalmology. Published online February 25, 2015. Abstract

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