Elsevier

Ophthalmology

Volume 116, Issue 10, October 2009, Pages 1913-1919
Ophthalmology

Original article
Age-related Macular Degeneration and Risk of Coronary Heart Disease and Stroke: The Cardiovascular Health Study

Presented at: The Macula Society Meeting, May 2007, London, England.
https://doi.org/10.1016/j.ophtha.2009.03.046Get rights and content

Purpose

To examine the associations of age-related macular degeneration (AMD) with incident coronary heart disease (CHD) and stroke in the Cardiovascular Health Study.

Design

Population-based prospective cohort study.

Participants

A total of 1786 white and African-American participants free of CHD or 2228 participants free of stroke, aged 69 to 97 years.

Methods

AMD was evaluated from photographs taken in 1997 and 1998.

Main Outcome Measures

Incident CHD and stroke ascertained using standardized methods.

Results

Of the 1786 persons free of CHD, 303 developed incident CHD over 7 years. Participants with early AMD (n = 277) had a higher cumulative incidence of CHD than participants without early AMD (25.8% vs. 18.9%, P = 0.001). By adjusting for age, gender, race, systolic and diastolic blood pressure, hypertension status, fasting glucose, triglyceride, low-density lipoprotein cholesterol, cigarette smoking, pack years of smoking, and C-reactive protein, the presence of early AMD was associated with an increased risk of incident CHD (hazard ratio 1.57; 95% confidence interval, 1.17–2.22). Late AMD (n = 25) was not associated with incident CHD (hazard ratio 0.78; 95% confidence interval, 0.25–2.48). Among 2228 persons at risk, 198 developed incident stroke; neither early nor late AMD was associated with incident stroke.

Conclusions

This study suggests persons with early AMD have a higher risk of CHD but not stroke in a population aged 69 to 97 years. This provides further support that AMD is associated with underlying systemic vascular disease.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The Cardiovascular Health Study (CHS) is a population-based cohort study of CVD in adults 65 years of age and older.22 The study sample and conduct have been described in detail.23 In brief, recruitment of the original cohort of 5201 persons took place at 4 field centers in the United States from 1989 to 1990. An additional 687 eligible African-Americans were recruited from Forsyth County, Sacramento County, and Allegheny County from 1992 to 1993. The total number of participants enrolled in

Results

Among the 1786 participants free of CHD, 277 had early AMD and 25 had late AMD. After 7 years of follow-up (average follow-up, 6 years), there were 303 persons who developed an incident CHD event. Among 2228 persons free of stroke, there were 198 incident stroke events over a 7-year period.

There were 1715 participants free of both CHD and stroke, consisting of 1450 whites and 265 African-Americans. The prevalence of AMD was 17.0% (292 persons). There were 268 (15.6%) early AMD cases and 24

Discussion

In the current study, we examined prospectively the relationship of AMD to 7-year incident CHD and stroke in a population aged 69 to 97 years. Our study demonstrates that older persons with early AMD signs are at higher risk of CHD events than persons without these signs. This association was independent of age, gender, race, systolic and diastolic blood pressure, hypertension, fasting glucose, diabetes, triglyceride, pack-years of smoking, current smoking status, LDL cholesterol, and CRP. Late

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  • Cited by (0)

    Manuscript no. 2008-1438.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    The research reported in this article was supported by the National Heart, Lung, and Blood Institute (contracts N01-HC-85079 to N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, and U01 HL080295], with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by the National Heart, Lung, and Blood Institute, National Institute of Health (grant number R21-HL077166) and the Sylvia and Charles Viertel Clinical Investigator Award (TYW). A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm. The sponsor or funding organization had no role in the design or conduct of this research.

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