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Patients with Age-related Macular Degeneration Have Increased Susceptibility to Valvular Heart Disease
Natan Lishinsky-Fischer1, Itay Chowers1, Yahel Shwartz1
1Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Patients with age-related macular degeneration (AMD) show a higher prevalence of valvular heart disease (VHD). This study found AMD patients are more likely to undergo heart valve procedures, highlighting a significant link between these conditions.
Area of Science:
- Ophthalmology
- Cardiology
- Medical Research
Background:
- Valvular heart disease (VHD) is a major global health concern.
- Aortic valve stenosis is a common cardiovascular disease.
- Emerging research suggests a link between VHD and subretinal drusenoid deposits (SDDs), a form of age-related macular degeneration (AMD).
Purpose of the Study:
- To investigate the association between AMD and VHD.
- To examine the relationship between SDDs and VHD.
Main Methods:
- Retrospective case-control study involving 945 AMD patients and 8275 controls.
- Spectral-domain OCT (SD-OCT) used for AMD assessment.
- Electronic medical records analyzed for VHD diagnoses and procedures.
Main Results:
- AMD patients exhibited higher rates of VHD, including aortic stenosis, aortic regurgitation, and mitral valve regurgitation.
- AMD patients were more likely to undergo aortic and tricuspid valve replacement procedures.
- A machine learning model identified AMD based on VHD history; no VHD difference was found between AMD subgroups (neovascular vs. nonneovascular) or based on SDDs.
Conclusions:
- Age-related macular degeneration (AMD) is associated with a higher prevalence of valvular heart disease (VHD).
- Patients with AMD have an increased likelihood of undergoing heart valve procedures.
- Subretinal drusenoid deposits (SDDs) did not show a differential association with VHD within the AMD cohort.
Purpose:
Valvular heart disease (VHD) contributes significantly to cardiovascular-related morbidity worldwide. Aortic valve stenosis is the third most common cardiovascular disease in the Western world, after hypertension and coronary artery disease. Recent studies have reported an association between VHD and the presence of subretinal drusenoid deposits (SDDs), a distinct manifestation of age-related macular degeneration (AMD). However, these findings were based on self-reported questionnaires and relatively modest cohort sizes. Our goal was therefore to investigate the putative associations between AMD and VHD and between the presence of SDDs and VHD.
Design:
Retrospective case-control study.
Subjects:
A total of 945 with AMD and 8275 control patients without AMD from a single tertiary center.
Methods:
All patients with AMD underwent spectral-domain OCT (SD-OCT). The SD-OCT scans were annotated by 2 experienced graders. Among the patients with AMD, 547 had drusen and SDDs, and 398 had drusen only with no SDDs. We also extracted data from all 9220 patients' electronic medical records, including demographics and previous heart valve procedures based on International Classification of Diseases, ninth revision codes.
Main Outcome Measures:
Heart valve-related diagnoses and procedures performed in both patient groups.
Results:
Patients with AMD had a higher prevalence of various VHDs compared with the control group, including increased rates of aortic stenosis (odds ratio [OR], 2.00; 95% confidence interval (CI), 1.40-2.86; P < 0.001), aortic regurgitation (OR, 2.41; 95% CI, 1.49-3.91; P < 0.001), and mitral valve regurgitation (OR, 1.51; 95% CI, 1.13-2.01; P = 0.004). Heart valve procedures were also more prevalent among AMD patients including aortic valve replacement (OR, 1.70; 95% CI, 1.08-2.66; P = 0.019) and tricuspid valve replacement (OR, 3.99; 95% CI, 1.03-15.46; P = 0.03). Moreover, a supervised machine learning model successfully detected the presence of AMD based solemnly on the patient's history of VHD. In the AMD cohort, we found no significant difference in VHD prevalence between patients with nonneovascular AMD and patients with neovascular AMD, or between patients with SDDs and patients without SDDs.
Conclusions:
Patients with AMD have a higher prevalence of VHD and are more likely to undergo a heart valve-related procedure compared with patients without AMD, with no difference between patients with SDDs and patients without SDDs in the AMD cohort.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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