Relationships Among Glaucoma, Cardiovascular Diseases, and Mortality

INTRODUCTION: In order to better understand comorbidity rates and the associated risk of death in patients with glaucoma we retrospective analyzed two groups of subjects aged 50 years and above residing in Lombardy Region (Northern Italy) following them from January 1, 2017 to February 1, 2020 (just before the COVID-19 pandemic started in Italy). The two groups were all subjects with incident glaucoma in 2017 and a 3:1 random sample stratified by age and sex of subjects without glaucoma. Main outcome was overall survival. Other outcomes were incidence of cardiovascular diseases (heart attack, stroke, and peripheral arterial disease). METHODS: All data were taken from Lombardy Region administrative database and therefore the presence of glaucoma was ascertained using antiglaucoma drug prescriptions, being hospitalized or undergoing an intervention for glaucoma, and having a glaucoma exemption for healthcare co-payments. RESULTS: The study identified 14,138 incident cases of glaucoma and selected 42,414 subjects without glaucoma. The number of deaths was higher among glaucoma subjects (11.6%) compared to those without glaucoma (10.5%). The death hazard ratio (HR) for glaucoma subjects compared to controls was 1.07 (95% CI 1.01-1.14, p = 0.015) in the adjusted model. Similarly incidence of stroke was higher in glaucoma compared to non-glaucoma subjects (HR 1.10, 95% CI 1.01-1.20), while the incidence of heart attack and peripheral arterial disease during the follow-up period was similar in the two groups. HRs varied by age classes for death and peripheral arterial disease. Individuals with glaucoma showed higher comorbidity rates compared to those without glaucoma, particularly in diabetes mellitus (16.7% vs. 11.0%) and hypertension (62.2% vs. 58.1%). CONCLUSIONS: Our results show an increased risk of mortality in subjects with glaucoma compared to those without glaucoma, with age being a significant factor influencing outcomes. These findings suggest the importance of monitoring and managing comorbidities in individuals with newly incident glaucoma to potentially improve their overall health outcomes and quality of life.