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Thrombophilic risk factors for retinal vein occlusion.

ABSTRACT: The aim is to study risk factors for retinal vein occlusion (RVO), such as thrombophilic and cardiovascular risk factors (CRF). A retrospective consecutive case series of 60 patients with RVO was made, tested for CRF, hyperhomocysteinemia, lupic anticoagulant, antiphospholipid antibody and 5 gene variants: factor V (FV) Leiden (G1691A), factor II (PT G20210A), 5,1-methylenetetra-hydrofolate reductase (MTHFR; 677?C?>?T and 1298?A?>?C), plasminogen activator inhibitor 1 (PAI-1; 4?G/5?G). More than 1 CRF were present in 36 patients (60%), which had a significantly higher mean age at diagnosis (66.7?±?12.9 versus 59.5?±?13.7 with ?1 CRF, [t(57)?=?-2.05, p?=?0.045, d?=?0.54). Patients with thermolabile MTHFR forms with decreased enzyme activity (T677T or C677T/A1298C) had a significant lower mean age [57.6?±?15.1; t (58)?=?3.32; p?=?0.002; d?=?0.846] than patients with normal MTHFR enzyme activity (68.5?±?10.2). Regarding CRF and thermolabile forms of MTHFR, the mean age at diagnosis could be significantly predicted [F(2,56)?=?7.18; p?=?0.002] by the equation: 64.8 - 10.3?×?(thermolabile MTHFR) - 5.31?×?(???1CRF). Screening of MTHFR polymorphisms may be useful in younger RVO patients, particularly when multiple CRF are absent.

SUBMITTER: Vieira MJ

PROVIDER: S-EPMC6908668 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Thrombophilic risk factors for retinal vein occlusion.

Vieira Maria J MJ Campos António A do Carmo Anália A Arruda Henrique H Martins Joana J Sousa João P JP

Scientific reports 20191212 1

The aim is to study risk factors for retinal vein occlusion (RVO), such as thrombophilic and cardiovascular risk factors (CRF). A retrospective consecutive case series of 60 patients with RVO was made, tested for CRF, hyperhomocysteinemia, lupic anticoagulant, antiphospholipid antibody and 5 gene variants: factor V (FV) Leiden (G1691A), factor II (PT G20210A), 5,1-methylenetetra-hydrofolate reductase (MTHFR; 677 C > T and 1298 A > C), plasminogen activator inhibitor 1 (PAI-1; 4 G/5 G). More than ...[more]

PMID: 31831825

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Project description:PurposeTo identify risk factors associated with central retinal vein occlusion (CRVO) among a diverse group of patients throughout the United States.DesignLongitudinal cohort study.ParticipantsAll beneficiaries aged ? 55 years who were continuously enrolled in a managed care network for at least 2 years and who had ? 2 visits to an eye care provider from 2001 to 2009.MethodsInsurance billing codes were used to identify individuals with a newly diagnosed CRVO. Multivariable Cox regression was performed to determine the factors associated with CRVO development.Main outcome measuresAdjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of being diagnosed with CRVO.ResultsOf the 494 165 enrollees who met the study inclusion criteria, 1302 (0.26%) were diagnosed with CRVO over 5.4 (± 1.8) years. After adjustment for known confounders, blacks had a 58% increased risk of CRVO compared with whites (HR, 1.58; 95% CI, 1.25-1.99), and women had a 25% decreased risk of CRVO compared with men (HR, 0.75; 95% CI, 0.66-0.85). A diagnosis of stroke increased the hazard of CRVO by 44% (HR, 1.44; 95% CI, 1.23-1.68), and hypercoagulable state was associated with a 145% increased CRVO risk (HR, 2.45; 95% CI, 1.40-4.28). Individuals with end-organ damage from hypertension (HTN) or diabetes mellitus (DM) had a 92% (HR, 1.92; 95% CI, 1.52-2.42) and 53% (HR, 1.53; 95% CI, 1.28-1.84) increased risk of CRVO, respectively, relative to those without these conditions.ConclusionsThis study confirms that HTN and vascular diseases are important risk factors for CRVO. We also identify black race as being associated with CRVO, which was not well appreciated previously. Furthermore, we show that compared with patients without DM, individuals with end-organ damage from DM have a heightened risk of CRVO, whereas those with uncomplicated DM are not at increased risk of CRVO. This finding may provide a potential explanation for the conflicting reports in the literature on the association between CRVO and DM. Information from analyses such as this can be used to create a risk calculator to identify possible individuals at greatest risk for CRVO.

Project description:To determine risk factors associated with development of a branch retinal vein occlusion (BRVO) among a large group of managed-care plan beneficiaries in the United States.Retrospective, longitudinal cohort study.All beneficiaries age ?55 years continuously enrolled for ?2 years in a managed care network from 2001-2009 who had ?2 visits to an eye care provider.Multivariable Cox regression analyses identified sociodemographic factors, ocular and nonocular conditions associated with incident BRVO.Hazard of incident BRVO with 95% confidence interval (CI).Of the 492,488 enrollees who met inclusion criteria, 2283 (0.5%) developed incident BRVO. After adjustment for confounding factors, blacks (adjusted hazard ratio [aHR], 1.43; CI, 1.19-1.73; P = 0.0001) had a 43% increased hazard of BRVO relative to non-Hispanic whites. Enrollees with hypertension (HTN) alone (aHR, 1.78; CI, 1.36-2.32; P?<?0.0001) or HTN along with other metabolic syndrome components (diabetes mellitus [DM] and hyperlipidemia; aHR, 1.44; CI, 1.12-1.84; P = 0.005) had an increased hazard of developing a BRVO compared with those with none of these conditions. Disease severity was important; enrollees with end-organ damage caused by HTN had a 107% increased hazard of developing BRVO compared with enrollees without HTN (aHR, 2.07; CI, 1.75-2.45; P?<?0.0001). Although there was no association between DM without end-organ damage and BRVO (aHR, 0.92; CI, 0.81-1.04; P = 0.2), individuals with end-organ damage from DM had a 36% increased hazard of BRVO (aHR, 1.36; CI, 1.18-1.57; P < 0.0001) compared with those without DM. Although cerebrovascular accident was associated with an increased hazard of developing BRVO (aHR, 1.34; CI, 1.19-1.52; P?<?0.0001), other diseases of the vascular system (deep venous thrombosis/pulmonary embolism, peripheral vascular disease, hypercoagulable state, myocardial infarction) or anticoagulant use did not increase the risk of BRVO (P?>?0.10 for all comparisons).Both HTN and end-organ damage from DM contribute to arteriosclerosis, atherosclerosis, and endothelial dysfunction, which seem to be major risk factors for BRVO. Ophthalmologists should emphasize to patients and their primary physicians the importance of effectively managing systemic medical conditions associated with BRVO.

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Thrombophilic risk factors for retinal vein occlusion.

Publications

Thrombophilic risk factors for retinal vein occlusion.

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