Age-Related Macular Degeneration and Coronary Artery Disease
Age-Related Macular Degeneration and Coronary Artery Disease
Objectives: Age-related macular degeneration (AMD) is the leading cause of blindness in the United States. Although AMD shares multiple risk factors with coronary artery disease (CAD), the association between AMD and CAD has not been established. The objective of our study was to demonstrate an association between the diagnosis of AMD and CAD and/or major cardiovascular risk factors.
Methods: We performed a retrospective chart review of >13,000 patients at the Lexington Veterans Affairs Medical Center. Patients diagnosed as having AMD served as cases, and patients diagnosed with cataract and no AMD served as controls. We examined the prevalence of CAD and associated risk factors in both groups using univariate analysis followed by multivariate analyses to examine the association between AMD and CAD after adjusting for known common risk factors.
Results: We identified 3950 patients with AMD and 9166 controls. Patients with AMD were on average 6 years older than controls (P < 0.001) and had a significantly higher prevalence of CAD (39% vs 34%) and hypertension (88% vs 83%) but lower incidence of diabetes mellitus and smoking. Estimated odds ratio relating CAD to AMD was 1.22 (95% confidence interval 1.13–1.32; P < 0.001). The association between CAD and AMD remained significant in multivariate analyses in older individuals (76 years and older). When we conducted a secondary analysis and matched the AMD and non-AMD groups based on age, the association between CAD and AMD remained significant (39.4% in the AMD group vs 36.6% in the non-AMD group; P = 0.011).
Conclusions: These findings support the existence of an association between CAD and AMD, particularly in older adult patients in the predominantly male Veterans Affairs population. Such an association between AMD and systemic vascular disease justifies the potential coscreening for these conditions.
Age-related macular degeneration (AMD) is the most common cause of blindness in the United States. It is a degenerative disease of the central area of the retina known as the macula, which results primarily in loss of central vision. The etiology of AMD remains unclear; however, epidemiologic studies have demonstrated an association with cardiovascular risk factors such as hypertension, smoking, elevated serum cholesterol, inflammatory state with elevated C-reactive protein, genetic predispositions, and postmenopausal state.
Coronary artery disease (CAD) is one of the leading causes of mortality in the United States. The overlap of risk factors between AMD and CAD is remarkable because AMD may then be regarded as a predictor of CAD and modifiable risk factors for CAD can be controlled to reduce the risk for both AMD and CAD. Although retrospective analyses have demonstrated the association between AMD and stroke or CAD, the association with CAD has been less defined and rather controversial.
It has been proposed that the same pathological mechanisms that cause lipid deposition in the walls of systemic arteries in aging and atherosclerosis also lead to esterified lipid-rich deposition and apolipoprotein-B lipid deposition in the sclera and the Bruch membrane of the choroid with AMD. This yields increased choroidal vascular resistance, resulting in elevated choriocapillary pressure, the development of subretinal deposits (drusen), and age-related maculopathy, as well as decreased choroidal blood flow.
The aim of this retrospective study was to examine a potential association between AMD and CAD (or its risk factors), including hypertension, age, diabetes mellitus, hyperlipidemia, and tobacco abuse, in a large sample of Veterans Affairs (VA) patients.
Abstract and Introduction
Abstract
Objectives: Age-related macular degeneration (AMD) is the leading cause of blindness in the United States. Although AMD shares multiple risk factors with coronary artery disease (CAD), the association between AMD and CAD has not been established. The objective of our study was to demonstrate an association between the diagnosis of AMD and CAD and/or major cardiovascular risk factors.
Methods: We performed a retrospective chart review of >13,000 patients at the Lexington Veterans Affairs Medical Center. Patients diagnosed as having AMD served as cases, and patients diagnosed with cataract and no AMD served as controls. We examined the prevalence of CAD and associated risk factors in both groups using univariate analysis followed by multivariate analyses to examine the association between AMD and CAD after adjusting for known common risk factors.
Results: We identified 3950 patients with AMD and 9166 controls. Patients with AMD were on average 6 years older than controls (P < 0.001) and had a significantly higher prevalence of CAD (39% vs 34%) and hypertension (88% vs 83%) but lower incidence of diabetes mellitus and smoking. Estimated odds ratio relating CAD to AMD was 1.22 (95% confidence interval 1.13–1.32; P < 0.001). The association between CAD and AMD remained significant in multivariate analyses in older individuals (76 years and older). When we conducted a secondary analysis and matched the AMD and non-AMD groups based on age, the association between CAD and AMD remained significant (39.4% in the AMD group vs 36.6% in the non-AMD group; P = 0.011).
Conclusions: These findings support the existence of an association between CAD and AMD, particularly in older adult patients in the predominantly male Veterans Affairs population. Such an association between AMD and systemic vascular disease justifies the potential coscreening for these conditions.
Introduction
Age-related macular degeneration (AMD) is the most common cause of blindness in the United States. It is a degenerative disease of the central area of the retina known as the macula, which results primarily in loss of central vision. The etiology of AMD remains unclear; however, epidemiologic studies have demonstrated an association with cardiovascular risk factors such as hypertension, smoking, elevated serum cholesterol, inflammatory state with elevated C-reactive protein, genetic predispositions, and postmenopausal state.
Coronary artery disease (CAD) is one of the leading causes of mortality in the United States. The overlap of risk factors between AMD and CAD is remarkable because AMD may then be regarded as a predictor of CAD and modifiable risk factors for CAD can be controlled to reduce the risk for both AMD and CAD. Although retrospective analyses have demonstrated the association between AMD and stroke or CAD, the association with CAD has been less defined and rather controversial.
It has been proposed that the same pathological mechanisms that cause lipid deposition in the walls of systemic arteries in aging and atherosclerosis also lead to esterified lipid-rich deposition and apolipoprotein-B lipid deposition in the sclera and the Bruch membrane of the choroid with AMD. This yields increased choroidal vascular resistance, resulting in elevated choriocapillary pressure, the development of subretinal deposits (drusen), and age-related maculopathy, as well as decreased choroidal blood flow.
The aim of this retrospective study was to examine a potential association between AMD and CAD (or its risk factors), including hypertension, age, diabetes mellitus, hyperlipidemia, and tobacco abuse, in a large sample of Veterans Affairs (VA) patients.
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