Association between retinal vascular disease and subsequent stroke risk: a nationwide cohort study.

BACKGROUND

Retinal vascular diseases (RVDs), including retinal vascular occlusion (RVO), diabetic retinopathy (DR) and retinal haemorrhage (RH), share pathophysiologic features with cerebral microvasculature and may serve as indicators of subsequent stroke risk.

AIMS: This study aimed to evaluate the associations of RVDs with ischemic stroke (IS) and hemorrhagic stroke (HS) in a nationwide cohort.

METHODS

Using data from the Korean National Health Insurance Service-National Sample Cohort (2002-2013), patients diagnosed with RVD were matched 1:10 with age- and sex-matched controls. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) for IS and HS, adjusting for demographic, lifestyle and clinical covariates.

RESULTS

A total of 1365 patients with RVO, 975 with DR and 836 with RH were included. Compared with controls, patients with RVO (aHR: 1.82; 95% CI: 1.45-2.28), DR (aHR: 1.70, 95% CI: 1.32-2.21) and RH (aHR: 1.55, 95% CI: 1.18-2.05) had significantly higher IS risk. RVO was also associated with increased HS risk (aHR: 2.44, 95% CI: 1.39-4.29). Stratified analyses demonstrated stronger relative risks in individuals younger than 60 years. Socioeconomic disadvantage, obesity, smoking and heavy alcohol consumption further modified the risk of stroke.

CONCLUSIONS

RVDs, particularly RVO, were significantly associated with elevated risks of both IS and HS. These findings highlight the potential value of retinal assessment in early identification of high-risk individuals and underscore the importance of tailored stroke prevention strategies, particularly in younger and socioeconomically vulnerable populations.