Age-Related Macular Degeneration and Risk of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study
Presented at: Association for Research in Vision and Ophthalmology meeting, May 2006, Fort Lauderdale, Florida.
Received 6 January 2006; accepted 7 June 2006.
Objective
To examine the association of age-related macular degeneration (AMD) with incident coronary heart disease (CHD) and all-cause mortality.
Design
Population-based prospective cohort study.
Participants
From the Atherosclerosis Risk in Communities Study (n = 12 536; age range, 49–73 years).
Methods
Participants had retinal photographs of one eye taken between 1993 and 1995. Photographs were evaluated for the presence of early and late AMD signs according to the Wisconsin grading system. Incident CHD events (acute myocardial infarction, silent myocardial infarction, fatal CHD, and cardiac revascularization procedures) and all-cause mortality were identified prospectively using standardized methods.
Main Outcome Measures
Incident CHD events and all-cause mortality.
Results
Of 11 414 persons at risk of CHD, there were 555 (4.9%) with AMD at baseline, of whom 540 were early AMD and 15 were late AMD cases. Over a 10-year follow-up, 922 persons developed an incident CHD event. After controlling for age, gender, race, systolic and diastolic blood pressure, pack-years of cigarette smoking, and other variables, early AMD was not associated with incident CHD (relative risk, 1.08; 95% confidence interval, 0.82–1.42). However, individuals with late AMD were significantly more likely to have an incident CHD event, with 4 CHD events among the 15 participants with late AMD at baseline (10-year cumulative incidence, 30.9%) as compared with 918 CHD events among the 11 399 participants without late AMD (incidence of 10.0%; P = 0.049, Fisher exact test). In the full cohort (n = 12 536), early AMD was not significantly associated with all-cause mortality. However, individuals with late AMD were more likely to die (10-year cumulative mortality rate, 23.5%) than those without late AMD (mortality rate, 8.9%; P = 0.088, Fisher exact test).
Conclusions
These data provide no evidence of an association between early AMD signs with incident CHD and all-cause mortality in middle-aged persons. Individuals with late AMD appear to have a higher rate of CHD events than those without late AMD, but due to a small number of late AMD cases, this finding should be interpreted cautiously.
1Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
2Singapore Eye Research Institute, Singapore National Eye Centre and National University of Singapore, Singapore.
3Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin.
4Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Correspondence to Tien Yin Wong, MD, PhD, Retinal Vascular Imaging Centre, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia.
Manuscript no. 2006-45.
This collaborative study was supported by the National Heart, Lung, and Blood Institute, Bethesda, Maryland (contract nos.: N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, N01-HC-55022). Additional support was provided by the National Institutes of Health, Bethesda, Maryland (grant no.: EYO13939 [TYW, RK]); Science, Technology and Innovation Grant, Melbourne, Australia (TYW); and Sylvia and Charles Viertel Award, Victoria, Australia (TYW).
ABSTRACT