Risk of Retinal Vascular Occlusive Disease According to Type and Low-Density Lipoprotein-Cholesterol Control after Acute Coronary Syndrome

Abstract

Purpose: Retinal vascular occlusive disease (RVOD) may occur as a consequence of systemic vascular dysfunction. Although RVOD has been associated with coronary artery disease, its incidence after acute coronary syndrome (ACS) and the influence of lipid control remain unclear. Materials and Methods: Using data from the Korean National Health Information Database (2002–2022), we conducted a nationwide retrospective cohort study including 55040 patients with newly diagnosed ACS [unstable angina (UA) or myocardial infarction (MI)] and age- and sex-matched controls. RVOD outcomes included retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Low-density lipoprotein-cholesterol (LDL-C) control was stratified into four categories (excellent, good, suboptimal, poor) based on guideline-recommended targets. Competing risk analysis was performed to estimate adjusted hazard ratios (aHRs). Results: The risk of RVOD was higher in both the UA group [aHR=1.67, 95% confidence interval (CI): 1.56–1.79] and MI group (aHR=1.34, 95% CI: 1.15–1.56) compared with controls. Stratified analysis showed elevated risk in older patients (≥65 years) and males. Among LDL-C groups, poor LDL-C control (≥100 mg/dL) was associated with the highest RVOD risk (aHR = 2.27), compared with both the ACS-free control group and the excellent control group (<55 mg/dL). Conclusion: ACS is independently associated with increased RVOD risk, particularly among patients with UA, older age, and poor LDL-C control. Intensive lipid-lowering therapy and ophthalmologic follow-up may reduce vision-threatening vascular events in this high-risk population.