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Sohil Bhagat, Aditya Uppuluri, Marco A Zarbin, Neelakshi Bhagat; Risk Factors for Central Retinal Artery Occlusion in Older Adults with Atrial Fibrillation and Flutter. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3171.
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Several risk factors have been identified for central retinal artery occlusion (CRAO) in older populations. Its underlying pathophysiology is similar to that of a non-hemorrhagic ischemic cerebrovascular accident and includes a multitude of prothrombotic systemic risk factors. This observational study uses the National Inpatient Sample (NIS) Database to evaluate the systemic and ocular risk factors associated with developing CRAO in the senior population (age > 65 years) with atrial fibrillation and flutter (AFF).
We conducted a retrospective cross-sectional case-control analysis using the NIS Database, 2002-2014, to evaluate systemic risk factors for CRAO in seniors with AFF. Cases were comprised of inpatients over 65 years of age who were admitted for CRAO and had AFF. The age and gender matched control group included inpatients over 65 years of age with AFF but without CRAO. The ratio of cases to controls was 1:5. Chi square analysis and logistic regression analyses were performed with a Bonferroni correction (alpha significance of 0.0029). An odds ratio was obtained for every significant variable.
We identified 740 weighted cases of AFF with CRAO and 3689 weighted controls of AFF without CRAO. The mean ages of the case and control groups were 79.2 and 79.4 years, respectively (p=0.452). Men comprised of 55.6% of the cases and 55% of the controls (p=0.759). Systemic comorbidities that significantly (p<0.0029) increased the risk of CRAO in these subjects included carotid stenosis (OR=23.38), history of stroke (OR=2.56), hypertension (OR=1.80), and hyperlipidemia (OR=1.75). A decreased risk was noted with bleeding diathesis (OR=0.26), and diabetes mellitus (OR=0.54); also, Hispanic ethnicity had a much lower risk of CRAO compared to Whites (OR=0.18).
The risk of CRAO in seniors with AFF increased 24 fold with carotid stenosis. Concurrent medical history of either hyperlipidemia, hypertension, or stroke doubled the risk of CRAO in this population, whereas, having a bleeding diathesis, or uncomplicated diabetes mellitus had a protective effect on developing central retinal artery occlusion.
This is a 2021 ARVO Annual Meeting abstract.
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