Increased non-cardiovascular mortality in patients with retinal vein occlusion

INTRODUCTION: Retinal vein occlusion (RVO) has shown a strong association with systemic cardiovascular risk factors and cardiovascular mortality, but some studies have also reported an increase in non-cardiovascular mortality in these patients. METHODS: A prospective case-control study was conducted between 2009 and 2019 at Marqués de Valdecilla University Hospital, involving 333 patients with a first episode of retinal vein occlusion (RVO) and 333 age- and sex-matched controls. Patients were referred to internal medicine after diagnosis based on clinical and angiographic criteria. Clinical data were collected using a standardized questionnaire, including cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, smoking, alcohol use and BMI. Median follow-up was 11 years. Overall, cardiovascular and non-cardiovascular mortality were recorded in both groups. Cox regression identified variables linked to overall, cardiovascular and non-cardiovascular mortality. All analyses were adjusted by individual's age (at the mean point of the follow-up). RESULTS: A total of 666 participants (mean age 67.6 years, 52% men) were included (333 in the RVO group and 333 controls). At ≥5 years, mortality was 25% in the RVO group and 24% in controls, with no significant differences in age or sex of deceased individuals. RVO patients had significantly higher prevalence of hypertension (73%), dyslipidemia (66%) and diabetes (25%) compared to controls. No significant differences were found in smoking, alcohol use, or BMI. Most RVO cases (67%) involved the temporal branch; 31.5% were central RVO. RVO was associated with increased overall mortality (HR 1.98, P = 0.002) and non-cardiovascular mortality (HR 2.48, P = 0.007), but not cardiovascular mortality (HR 1.86, P = 0.11). No mortality differences were found between branch and central RVO types. CONCLUSION: In our cohort the patients with RVO show increased mortality from non-cardiovascular causes, suggesting it may indicate broader systemic disease. This highlights the need for comprehensive medical evaluation and management beyond just cardiovascular risk.