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Age-related macular degeneration and risk of stroke and all-cause mortality
Bhrugun Anisetti1, Michael W Stewart2, Daniela Markovic3
1Department of Neurology, Mayo Clinic, Jacksonville, Florida, United States.
Insights
Age-related macular degeneration (AMD) is linked to a higher risk of stroke and mortality. This association persists even after accounting for age and common vascular risk factors.
Area of Science:
- Ophthalmology
- Neurology
- Gerontology
Background:
- Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults.
- While retinal vascular diseases are linked to cardiovascular issues, the AMD-stroke connection requires further investigation.
- This study examines the relationship between AMD, stroke incidence, and mortality.
Purpose of the Study:
- To investigate the association between age-related macular degeneration (AMD) and stroke risk.
- To determine if AMD is linked to increased all-cause mortality.
- To analyze these relationships independently of age and vascular risk factors.
Main Methods:
- Utilized data from US National Health and Nutrition Examination Surveys (2005-2008) with mortality follow-up to 2015.
- Included participants aged 40+ with gradable AMD, classifying it as early or late stage.
- Employed multivariable logistic and Cox regression models to assess AMD's independent association with stroke and mortality.
Main Results:
- AMD was significantly associated with an increased risk of stroke (aOR 1.87).
- Both early (aOR 1.66) and late AMD (aOR 3.32) showed increased stroke risk.
- Participants with AMD experienced higher all-cause mortality (HR 1.35), with late AMD showing a HR of 2.18.
Conclusions:
- Age-related macular degeneration is an independent risk factor for stroke and all-cause mortality.
- Findings suggest potential non-vascular pathways contributing to AMD's association with stroke.
- Further research into these mechanisms is warranted.
Introduction:
Age-related macular degeneration (AMD) is the most common degenerative disorder of the retina and choroid. Retinal vascular diseases have been associated with adverse cardiovascular outcomes, but an association between AMD and stroke has not been well established. We aimed to test the relationship between AMD, stroke, and age-adjusted mortality.
Material And Methods:
Data was obtained from the US National Health and Nutrition Examination Surveys 2005 to 2008, with linked mortality through to 2015. Participants aged 40 or older with gradable AMD on fundus photographs were included. AMD was classified as either early or late. Independent relationships between AMD and stroke were assessed using multivariable logistic regression models. Risk of all-cause mortality was assessed using Cox regression models, before and after adjusting for covariates.
Results:
Of the 5,481 participants included, 49.8% were women, 56.5% white, 20.3% black, and 15.5% Hispanic. 425 (7.8%) had AMD. After adjusting for vascular risk factors, we found that AMD was associated with an increased risk of stroke (aOR 1.87, 95% CI 1.25-2.79, p = 0.002). There was a relationship between AMD and stroke depending on whether participants had early AMD (aOR 1.66, 95% CI 1.09-2.51) or late AMD (aOR 3.32, 95% CI 1.36-8.12). All-cause mortality was higher in those with AMD (HR 1.35, 95% CI 1.06-1.72) and late AMD (HR 2.18, 95% CI 1.33-3.58).
Conclusions:
Age-related macular degeneration is associated with stroke and all-cause mortality, independent of age and vascular risk factors. Our findings suggest potential non-vascular mechanisms related to the aetiology of AMD may increase the risk of stroke.
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