Association between non-arteritic anterior ischaemic optic neuropathy and cardiovascular events: A retrospective, propensity score-matched cohort study using the TriNetX network

Background The cardiovascular risk following non-arteritic anterior ischaemic optic neuropathy (NAION) remains uncertain. Objective To assess 1-year mortality and cardiovascular events after an initial recorded episode of NAION. Methods We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. The primary outcome was 1-year all-cause mortality. Secondary outcomes were ischaemic and haemorrhagic stroke, acute myocardial infarction (AMI), heart failure (HF), and atrial fibrillation (AF). Results Between 2015 and 2024, 17,217 patients with an initial episode of NAION and 1,503,464 with age-related cataract were identified. Propensity score matching on 59 demographic, clinical, pharmacological, and laboratory covariates yielded 17,208 patients per group with balanced baseline characteristics. At 1 year, NAION was associated with increased all-cause mortality (OR, 1.38; 95% CI, 1.14–1.68; p = 0.001), ischaemic stroke (OR, 3.26; 95% CI, 2.73–3.91; p < 0.001), haemorrhagic stroke (HR, 2.23; 95% CI, 1.51–3.31; p < 0.001), and AMI (HR, 1.33; 95% CI, 1.03–1.73; p = 0.031). No significant association was observed with HF (HR, 1.10; 95% CI, 0.91–1.32; p = 0.324) or AF (HR, 1.11; 95% CI, 0.93–1.33; p = 0.228). Conclusion An initial recorded episode of NAION was associated with increased 1-year mortality, stroke, and AMI, but not HF or AF. These findings support considering NAION as a marker of increased short-term cardiovascular risk and prompt cardiovascular assessment.