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Early AMD may be a marker for CVD in patients under 75 years

A prospective study has found that early age-related macular degeneration (AMD) can predict 10-year CVD risk in patients younger than 75 years.

A prospective study has found that early age-related macular degeneration (AMD) can predict 10-year CVD risk in patients younger than 75 years.

A prospective study, in the British Journal of Ophthalmology, has found that early age-related macular degeneration (AMD) can predict 10-year CVD risk in patients younger than 75 years.

The study, from Australia, recruited 3,654 patients aged >49 years between 1992 and 1994. Of these, 2,335 were re-examined at five years and 1,952 at ten years. Retinal photography was performed and images were graded for AMD using the Wisconsin System. History and physical examination provided data on risk factors. Deaths and causes of death were identified using the Australian National Death Index.

The results showed that, after adjustment for age, sex, smoking history, hypertension, BMI and diabetes, early AMD was associated with a twofold increase in cardiovascular mortality over ten years in patients aged 49-75 (relative risk 2.32, 95% CI 1.03-5.19).

Late AMD was associated with a fivefold increase in cardiovascular mortality (relative risk 5.57; 95% CI 1.35-22.99) and a tenfold increase in stroke mortality (relative risk 10.21; 95% CI 2.39-43.60). However, these were only adjusted for age and sex as there were too few patients with late AMD to perform multivariant analysis.

These associations disappeared when patients >75 years of age were included in the analysis.

It would appear that early AMD may independently predict CVD over a ten-year period in patients aged 49-75 years. AMD is one of the most common causes of blindness in the developed world. It shares several risk factors with CVD and therefore could be a marker for occult vascular disease.

However, I would exercise some caution with respect to the late AMD findings because of the small sample size and subsequent lack of multivariant analysis. These associations could be explained by a common pathological process, such as atherosclerosis with inflammation, oxidative stress or endothelial dysfunction, and are not unlike the association between other pathological entities and CVD, such as chronic kidney disease and erectile dysfunction.

Tan JSL, Wang JJ, Liew G et al. Age-related macular degeneration and mortality from cardiovascular disease or stroke. Br J Ophthalmol 2008;92:509-12

Reviewer

Dr Peter Savill
GPwSI Cardiology, Southampton

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