Retinal vein and artery occlusions: a risk factor for stroke in atrial fibrillation

Abstract

Summary. Background: Retinal vascular occlusions may constitute an independent risk factor for stroke in patients with atrial fibrillation. Methods: We performed a retrospective study on a nationwide cohort with atrial fibrillation from 1997 to 2008. The rate of stroke/systemic thromboembolism (TE)/transitory ischemic attack (TIA) was determined for atrial fibrillation patients with and without a history of retinal vascular occlusion. A Cox regression analysis, adjusted for risk factors and medications, was performed to determine the independent predictive value of retinal arterial or venous occlusion for the risk of ischemic stroke, TE or TIA in atrial fibrillation patients. Results: We included 87 202 patients with nonvalvular atrial fibrillation. At baseline, a history of retinal arterial occlusion was diagnosed in 224 patients (0.26%) and a history of retinal venous occlusion in 361 (0.41%). Patients without retinal occlusion had a rate of stroke/TE/ TIA of 4.52 (95% confidence interval [CI] 4.44-4.60). For patients with retinal arterial occlusion, the rate of stroke/ TE/TIA was 8.16 (95% CI 6.35-10.49) per 100 personyears, and for patients with retinal venous occlusion it was 7.28 (95% CI 5.93-8.94) per 100 person-years. In multivariate analysis, both retinal arterial occlusions (hazard ratio [HR] 1.39, 95% CI 1.08-1.79) and retinal venous occlusions (HR 1.26, 95% CI 1.02-1.54) were associated with an increased risk of future stroke/TE/TIA. Conclusions: A history of retinal arterial or retinal venous occlusion is associated with an increased risk of stroke/TE/TIA in patients with atrial fibrillation. Thus, prior retinal vascular occlusion may be considered as a previous thromboembolic event when evaluating stroke risk in patients with atrial fibrillation.

Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review

“…The risk of stroke in RAO patients was significantly higher compared with RVO (Table 4). 4,5,10,13,15 This is perhaps consistent with expectations, based on their pathophysiological associations. The Danish study also found that in patients with established atrial fibrillation and coexisting RAO or RVO could accentuate the risk of incident stroke.…”

“…The Danish study also found that in patients with established atrial fibrillation and coexisting RAO or RVO could accentuate the risk of incident stroke. 13 As some of the increased risks associated with RVO were attributed to other adverse cardiovascular co-morbidities in these patients, it is more likely that RAO and RVO remain important independent predictors of future stroke in patients suffering from atrial fibrillation.…”

“…There was no significant difference in stroke rate when comparing central and branch RVO subgroups (6.5%), but was significantly higher at 19.6-25% in RAO (summarised in Table 4). 2,[4][5][6][7]10,13,15,17 The relationship between retinal vascular events and the various cardiovascular complications perhaps represents the presence of co-morbidities common to all. Conditions such as hypertension, hyperlipidemia, carotid artery disease, and diabetes mellitus are common risk factors associated with cardiovascular morbidity and mortality.…”

“…Table 2a shows reports on seven case-control studies: a stroke rate of 6.7-35.1% in RVO patients compared with 2.1-19.9% in controls. 4,5,[10][11][12][13][14] All except one study indicated a positive association with stroke risk amongst RVO patients. 4,5,10-13 Shih et al 4 reported no significant difference in stroke rate when comparing the CRVO (6.4%) and BRVO (6.8%) subgroups, but RVO remained a significant predictor for stroke development (after adjustment) among the age group of 60-69 years.…”

“…14 Two studies also recorded transient ischaemic attack occurrence alongside stroke incidence. 11,13 Figure 1 Flow chart on studies selection. Positive association combined RAO and RVO in one eye of 20%, but not any higher than the groups with lone RAO or RVO.…”