Cardiovascular risk following transient vision loss

To evaluate short- and long-term cardiovascular risk following a first diagnosis of transient vision loss (TVL) compared with matched controls using the TriNetX research network.

Patients with an incident diagnosis of TVL were retrospectively identified and 1:1 propensity score matched to controls with dry eye syndrome. Primary outcomes included major adverse cardiovascular events (MACE), stroke, myocardial infarction (MI), ventricular arrhythmias, venous thromboembolism (VTE), hospitalisation and all-cause mortality. Cox proportional hazards models estimated hazard ratios (HRs) from 14 days to 10 years. Subgroup analyses evaluated patients free of events at 90 days and 1 year.

After matching, 37 750 patients were included in each cohort. Mean (SD) age was 56.8 (16.8) years in the TVL cohort (59.7% female) and 56.6 (16.3) years in the control cohort (58.9% female). Within 14 days, stroke risk increased over 21-fold (HR 21.7; 95% CI 13.4 to 37.4), MACE nearly 10-fold (HR 9.80; 95% CI 7.19 to 13.34), arrhythmia over fourfold (HR 4.01; 95% CI 2.72 to 5.90), MI fivefold (HR 5.00; 95% CI 1.92 to 12.06) and hospitalisation nearly fourfold (HR 3.83; 95% CI, 3.52 to 4.17) compared with controls. VTE risk was modest and transient, with no elevation beyond 5 years and all-cause mortality was not elevated at any time point. Among patients' event-free at 90 days or 1 year, elevated long-term risk persisted up to 10 years for MACE, stroke, arrhythmiaand hospitalisation.

TVL is associated with increased short- and long-term risks of MACE, stroke, MI, arrhythmia and hospitalisation, warranting prompt systemic evaluation and long-term monitoring.