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Meta-analysis of the association between retinopathy and the risk of stroke
1The School of Medicine, Quzhou College of Technology, Quzhou, Zhenjiang, China.
Background:
Retinopathy, as a manifestation of systemic microvascular dysfunction, has been increasingly recognized as a potential indicator of cerebrovascular disease. However, evidence regarding the association between retinopathy and stroke risk remains inconsistent. This meta-analysis aimed to quantitatively evaluate the relationship between retinopathy and the risk of stroke.
Methods:
A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and CNKI from inception to June 12, 2025 to identify observational studies examining the association between retinopathy and stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Due to heterogeneity in retinopathy classification, only studies with comparable exposure definitions were included in the quantitative synthesis, while others were summarized qualitatively. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist, as appropriate.
Results:
A total of 23 studies were included, of which 10 were eligible for quantitative meta-analysis. The pooled results demonstrated that retinopathy was significantly associated with an increased risk of stroke (OR = 1.87, 95% CI: 1.50-2.33). Subgroup analyses indicated a graded relationship between retinopathy severity and stroke risk, with higher risks observed in more advanced stages. The association was generally consistent across subgroups stratified by country, age, and study characteristics. Sensitivity analyses confirmed the robustness of the findings. Although no significant publication bias was detected, a potential small-study effect could not be entirely excluded.
Conclusion:
This meta-analysis provides evidence that retinopathy is significantly associated with an increased risk of stroke, suggesting that retinal microvascular abnormalities may represent a promising marker associated with cerebrovascular risk. However, their predictive utility for clinical risk stratification requires further validation in prospective studies. Routine retinal assessment may aid in the early identification of high-risk individuals and inform targeted prevention strategies.
