Mount Sinai Research Suggests Retinal Vein Occlusion is linked to Heart Disease and Stroke

Results from the large-scale data analysis could help prevent serious cardiac and neurologic events

Title: Association of Retinal Vein Occlusion with Cardiovascular Events and Mortality – A Systematic Review and Meta-analysis

Journal and Link to Study: Retina 

https://journals.lww.com/retinajournal/Fulltext/2019/09000/ASSOCIATION_OF_RETINAL_VEIN_OCCLUSION_WITH.1.aspx

Senior Author: Avnish Deobhakta, MD, Assistant Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai

Bottom Line:  This is one of the first large-scale analysis of major published literature that shows a strong correlation between retinal vein occlusion (RVO- blockage of retinal veins) and cardiovascular disease/stroke.  The findings could help prevent RVO patients from having serious cardiac and neurological events.

Why this is important:  RVO is one of the most common retinal diseases and a major cause of vision loss in the middle aged and elderly populations, affecting 16 million people globally.  Risk factors for RVO include arterial hypertension, diabetes, hyperlipidemia and carotid artery plaque. Previous studies examining the association of RVO and cardiovascular/neurological events have been inconsistent.  This new, large-scale study, strongly links RVO to adverse cardiac events and mortality, demonstrating how serious these risk factors actually are.  

How research was conducted:  Researchers did a broad sweep of the existing published literature in well-established journals that evaluated the association of baseline RVO and cardiovascular events.  Overall they analyzed fifteen manuscripts that included nearly 475,000 patients (roughly 60,000 with RVO and 414,397 without RVO), and used specific statistical tools (called a meta-analysis) to determine if there was a relationship between vein blockages and heart disease. 

Conclusions: Researchers found RVO patients were at increased risk of stroke, heart attack, heart failure, and all-cause mortality, when compared to patients without RVO.  The highest association was for stroke.

Takeaways for Physicians: This study suggests that if/when ophthalmologists diagnose someone with RVO they should consider referring those patients to a cardiologist/neurologist, as they could be at higher risk for cardiovascular disease/stroke.  Ophthalmologists generally refer these patients to a general practitioner for evaluation of commonly checked metrics such as blood pressure and blood sugar, but this study may argue that physicians should be more aggressive in our referrals to cardiologists/neurologists.

Takeaways for Patients: As a patient, if you have been diagnosed with a retinal vein occlusion, see your primary care physician immediately and be proactive during the visit.  Ask if a referral to a cardiologist/neurologist would be appropriate given your history and symptoms.

Quotes from Dr. Deobhakta:  "This study suggests that we as retina specialists should probably be far more aggressive in referring our retinal vein occlusion patients out for specifically cardiac and neurological evaluation - ideally, we should be even more communicative with the primary care physician about these sorts of cardiac and neurological risks that these types of patients face,” Dr. Deobhakta explains. "Patients could be having subclinical strokes or cardiac changes and may not even recognize they're happening, so a referral to a specialist might be a necessary addition to our current treatment paradigm."

About Mount Sinai Health System

The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology and the South Nassau Communities Hospital is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.

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