Abstract
Background Increased lipoprotein (a) [Lp(a)] has been associated with enhanced risk of cardiovascular events and more recently with venous thromboembolism. However, there is inconclusive data on the association between enhanced Lp(a) and retinal vein occlusion (RVO). We aimed to assess the role of Lp(a) in RVO. Methods We performed a systematic review and meta-analysis of the studies addressing the role of Lp(a) in RVO. A systematic literature search was performed to identify all published papers reporting Lp(a) levels. Main outcome measures consisted of Lp(a) levels in patients with (cases) or without (controls) RVO. Results We included 13 studies for a total of 1,040 cases and 16,648 controls. Lp(a) levels above normal limits were associated with RVO (OR 2.38, 95% CI 1.7–3.34) and patients with RVO had higher Lp(a) levels than controls (weighted mean difference: 13.4 mg/dL, 95% CI 8.2–18.6). Conclusion Increased Lp(a) levels associate with RVO and should be included among diagnostic and prognostic indexes for this unusual-site vein thrombosis. Therapeutic interventions aimed to lower Lp(a) should be tested in RVO patients.
Highlights
Retinal vein occlusion (RVO) is due to the thrombotic obstruction of retinal veins
Several common cardiovascular risk factors, such as hypertension, diabetes, and hyperlipemia, were reported to be predisposing factors for RVO4 and to enhance the risk of RVO recurrence.[2,4]. These findings suggest that RVO is a venous thrombosis it has more characteristics in common with atherosclerosis than with venous thromboembolism (VTE).[3,4,5]
Out of 623 articles initially retrieved by our search strategy (35 Scopus, 556 Google Scholar, 32 PubMed), 610 were excluded because of reviews or case reports, studies not reporting Lp(a) plasma levels or studies in patients affected by retinal arterial thrombosis (►Fig. 1)
Summary
Retinal vein occlusion (RVO) is due to the thrombotic obstruction of retinal veins. Affecting 16 million people worldwide, RVO is the second most common retinal disease after diabetic retinopathy and it may be associated with serious consequences such as neurovascular glaucoma, retinal detachment, and blindness.[1] Based on the site of vascular occlusion RVO is distinguished in central retinal vein occlusion (CRVO), located in the central retinal vein at the passage through the lamina cribrosa, branch retinal vein occlusion (BRVO), involving one of the branches of the central retinal vein at an arteriovenous crossing, and hemispheric retinal vein occlusion (HRVO), involving the venous return from approximatively one half of the retina. Increased lipoprotein (a) [Lp(a)] has been associated with enhanced risk of cardiovascular events and more recently with venous thromboembolism. There is inconclusive data on the association between enhanced Lp(a) and retinal vein occlusion (RVO). We aimed to assess the role of Lp(a) in RVO
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