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Retinal vein occlusion linked to high cholesterol
Patients are at a higher risk of developing retinal vein occlusion if they have high-density lipoprotein cholesterol, according to a study conducted in the Department of Ophthalmology at Samsung Medical Center in Seoul, South Korea.
“Previous studies have reported that risk factors for [retinal vein occlusion] include old age, hypertension, diabetes mellitus, myocardial infarction, cerebral vascular accidents and chronic kidney disease,” Jaeryung Kim, MD, PhD, vascular biologist and ophthalmologist at the Samsung Medical Center at Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote.
“Although hyperlipidemia has also been considered to be a risk factor for [retinal vein occlusion], few studies to date have evaluated the association between high-density lipoprotein cholesterol (HDL-C) and [retinal vein occlusion] development,” the researchers said.
Kim and colleagues studied 23,149,403 Korean patients at least 20 years old who took the Korean National Health Screening Program examination between January 2009 and December 2012. These patients were monitored for development of retinal vein occlusion (RVO) and classified into four groups according to each individual’s HDL-C concentration quartiles. Age, sex, alcohol intake, smoking habits, regular exercise, income, diabetes mellitus, risk of stroke, heart disease, obesity and hypertension were analyzed.
Findings showed that patients who were at a younger age (younger than 65 years), male sex and had a current smoking habit, diabetes mellitus and hypercholesterolemia had higher association between the development of retinal vein occlusion and HDL-C.
“Our study provides the first evidence that HDL-C is a risk factor for RVO in almost the entire population,” Kim and colleagues wrote. “The assessment of lipid profiles including HDL-C level may be considered when encountering a newly diagnosed case of RVO.”
According to this study, low blood HDL-C is a significant independent risk factor for the development of RVO. Future studies are required to examine whether control of HDL-C can be used to decrease patients’ risk of developing RVO. – by Erin T. Welsh
Disclosure: The authors report no relevant financial disclosures.
Perspective
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This study shows that low HDL-C, the so-called “good cholesterol,” is a significant independent risk factor for RVO, the second most common retinal vascular disorder. Practically, it reminds us of the link between retinal diseases and systemic disease, in this case high cholesterol, and the need to comanage such patients with primary care physicians. It also reminds us that we should check lipid profiles on our patients with newly diagnosed vein occlusions. The study also points out other systemic risk factors for vein occlusion – such as hypertension, diabetes, obesity and smoking – that should also be evaluated and considered in our patients with RVOs.
This study was well powered, involving more than 117,000 patients with reported vein occlusion. However, all the patients in the study were Korean, so how this information relates to other ethnic groups is unclear. Further, while the study showed that low HDL-C is a risk factor for RVO, it did not examine if controlling HDL-C would decrease the risk of vein occlusion, but encouraged further studies to make that determination.
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Kim J, et al. Am J Ophthalmol. 2019;doi:10.1016/j.ajo.2019.04.001.
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