Cardiovascular Disease and Hypertension Are Strong Risk Factors for Choroidal Neovascularization
Received 7 December 2006; received in revised form 6 June 2007; accepted 27 July 2007. published online 22 October 2007.
Purpose
To investigate the association of cardiovascular risk factors and inflammatory markers with neovascular age-related macular degeneration (AMD).
Design
Cross-sectional case–control study.
Participants
Of the 410 of the ≥65-year-old community sample invited to attend, 205 participated (50% response rate). Of the 215 clinic attendees who were invited to participate, 212 agreed to take part (98% response rate). A diagnosis of neovascular AMD in at least one eye was made in 193 clinic attendees and 2 of the community sample.
Methods
Clinic and community participants underwent a detailed ophthalmic examination with fundus imaging, were interviewed for assessment of putative risk factors, and provided a blood sample. Analysis included levels of serum lipids, intercellular adhesion molecule 1 (ICAM), vascular cellular adhesion molecule (VCAM), and C-reactive protein (CRP). All participants were classified by fundus image grading on the basis of the eye with more severe AMD features.
Main Outcome Measure
Neovascular AMD.
Results
There were 195 participants with choroidal neovascularization in at least one eye, 97 nonneovascular AMD participants, and 115 controls (no drusen or pigmentary irregularities in either eye). In confounder-adjusted logistic regression, a history of cardiovascular disease was strongly associated with neovascular AMD (odds ratio [OR], 7.53; 95% confidence interval [CI], 2.78–20.41). Cigarette smoking (OR, 3.71; 95% CI, 1.25–11.06), being in the highest quartile of body mass index (OR, 3.82; 95% CI, 1.22–12.01), stage 2 hypertension (OR, 3.21; 95% CI, 1.14–8.98), and being in the highest quartile of serum cholesterol (OR, 4.66; 95% CI, 1.35–16.13) were positively associated with neovascular AMD. There was no association between AMD status and serum CRP, ICAM, or VCAM.
Conclusions
Our results suggest that cardiovascular disease plays an etiological role in the development of choroidal neovascularization in a proportion of older adults and highlight the importance of control of blood pressure and cholesterol, avoidance of smoking, and maintenance of a normal body weight.
Available online: October 22, 2007.
1Centre for Vision Sciences, Belfast, United Kingdom.
2Nutrition and Metabolism Group, Centre for Population Science, Belfast, United Kingdom.
3Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
4Ophthalmology Subdivision, Head and Skeletal Division, Royal Group of Hospitals Trust, Belfast, United Kingdom.
Correspondence to Prof Usha Chakravarthy, MD, PhD, Centre for Vision Sciences, Institute of Clinical Science, Royal Group of Hospitals, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, United Kingdom.
ABSTRACT