Subclinical carotid atherosclerosis in patients with retinal vein occlusion: Differential cardiovascular risk profiles

BACKGROUND: The burden of subclinical atherosclerosis in patients with retinal vein occlusion (RVO) remains incompletely understood. METHODS: Cross-sectional study of consecutive adult patients with RVO underwent cardiovascular risk assessment using SCORE2/SCORE2-OP and bilateral carotid ultrasonography. Patients were stratified into three groups: antiphospholipid syndrome (APS), conventional cardiovascular risk factors (CRF+), and those without (CRF-). Carotid plaque was defined according to Mannheim consensus criteria. Receiver operating characteristic (ROC) analysis evaluated the discriminative performance of SCORE2 in plaque detection. RESULTS: A total of 500 patients were included (55 APS; 413 CRF+ and 32 CRF-). Carotid plaque prevalence increased progressively across SCORE2 categories (27.1% in low-moderate, 55.6% in high, and 75.3% in very high risk; p < 0.001). APS patients demonstrated a plaque burden comparable to CRF+ individuals, with 55-75% plaque prevalence in high/very high-risk strata. Notably, plaque was detected in a subset of patients classified as low-moderate risk, particularly within the APS group. SCORE2/SCORE2-OP showed a moderate discrimination for plaque detection (AUC 0.76; 95% CI 0.72-0.80). CONCLUSIONS: RVO is associated with a substantial burden of subclinical atherosclerosis measured by carotid ultrasonography. APS confers an accelerated atherosclerotic phenotype comparable to conventional cardiovascular risk. SCORE2/SCORE2-OP tools alone may underestimate vascular burden in this population.