A new cross-cohort study has found that elevated high-sensitivity C-reactive protein levels may be associated with a higher risk of retinal artery occlusion and ischemic stroke.
The study, published in a recent BMJ article, included 459,188 participants from the UK Biobank and 338 participants from a Chinese cohort. Over a median follow-up of 12.2 years, 136 cases of retinal artery occlusion (RAO) and 3,206 cases of ischemic stroke (IS) were recorded in the UK Biobank data set. The analysis found that each 10 mg/L increase in high-sensitivity C-reactive protein (hs-CRP) was linked to a 34% higher risk of RAO (hazard ratio [HR] = 1.34, 95% confidence interval [CI] = 1.01–1.76). The same increase in hs-CRP was associated with a 24% higher risk of IS (HR = 1.24, 95% CI = 1.17–1.33). A nonlinear association was found between hs-CRP and IS, and patients with RAO with higher hs-CRP levels were more likely to experience IS (2.81 mg/L vs 10.14 mg/L, P < .001).
In the Chinese cohort, each 1 mg/L increase in hs-CRP was associated with a 43% higher risk of RAO (odds ratio [OR] = 1.43, 95% CI = 1.15–1.78) and a 13% higher risk of IS (OR = 1.13, 95% CI = 1.03–1.24).
RAO has been increasingly recognized as an early warning sign for IS. Given that RAO and IS share common vascular risk factors—including hypertension, diabetes, and hyperlipidemia—identifying patients with elevated hs-CRP could allow for earlier intervention strategies aimed at reducing stroke risk.
“Before the onset of RAO,” lead study author Yaxin Wang, of the Guangdong Eye Institute in the Department of Ophthalmology at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) at Southern Medical University, in Guangzhou, China, wrote with colleagues, “patients often experience vascular transient monocular visual loss, which is akin to a retinal [transient ischemic attack] (TIA). Considering the close connection between RAO, IS, and TIA, whether hs-CRP acts as a shared risk factor for these conditions and the role of hs-CRP in the sequential onset of these diseases are needed to be understood comprehensively,” they underscored.
The study relied on hospital records to define cases of RAO and IS, which may have led to underreporting. Additionally, hs-CRP measurements were taken at a single time point, which limited the ability to assess dynamic changes over time. Future studies should evaluate whether serial hs-CRP measurements can improve risk prediction models and whether interventions to lower hs-CRP could reduce the incidence of RAO and IS.
“In community screening efforts, clinicians can implement vigilant monitoring of hs-CRP levels to identify high-risk populations, especially in conjunction with other cardiovascular disease risk factors such as hypertension and hyperlipidaemia,” the study authors suggested. “This approach allows for tailored prevention and control measures to be offered to [patients] at elevated risk,” they concluded.
The researchers declared no competing interests
