Klein Ronald, Klein Barbara E K, Tomany Sandra C, Cruickshanks Karen J
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin 53726-2397, USA.
Ophthalmology. 2003 Apr;110(4):636-43. doi: 10.1016/S0161-6420(02)01448-3.
To examine the association between cardiovascular disease and its risk factors and the 10-year incidence of age-related maculopathy.
Population-based cohort study.
Persons 43 to 86 years of age at baseline examination from 1988 to 1990, living in Beaver Dam, Wisconsin, of whom 3684 persons participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up examination.
Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy. The Kaplan-Meier (product-limit) survival approach and discrete linear logistic regression were used in the data analysis.
Incidence and progression of age-related maculopathy.
When age, gender, and history of heavy drinking, smoking, and vitamin use were controlled for, higher systolic blood pressure at baseline was associated with the 10-year incidence of retinal pigment epithelial depigmentation (risk ratio [RR] per 10 mmHg systolic blood pressure, 1.10; 95% confidence interval [CI], 1.01-1.18; P = 0.02) and exudative macular degeneration (RR, 1.22; 95% CI, 1.06-1.41; P = 0.006). Higher pulse pressure at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR per 10 mmHg, 1.17; 95% CI, 1.07-1.28; P < 0.001), increased retinal pigment (RR, 1.10; 95% CI, 1.01-1.19; P = 0.03), exudative macular degeneration (RR, 1.34; 95% CI, 1.14-1.60; P < 0.001), and progression of age-related maculopathy (RR, 1.08; 95% CI, 1.01-1.17; P = 0.03). Higher serum high-density lipoprotein cholesterol at baseline was associated with pure geographic atrophy (RR per 10 mg/dl high-density lipoprotein cholesterol, 1.29; 95% CI, 1.05-1.58; P = 0.01). Physical activity at baseline was associated with the incidence of geographic atrophy (RR in those who worked up a sweat 5 times a week compared with those who did not, 0.12; 95% CI, 0.02-0.91; P = 0.04) exudative macular degeneration (RR, 0.27; 95% CI, 0.08-0.87; P = 0.05), and progression of age-related maculopathy (RR, 0.69; 95% CI, 0.47-1.00; P = 0.05). Neither a history of stroke nor heart attack was associated with the incidence or progression of age-related maculopathy.
These findings indicate relationships between higher pulse pressure (a presumed indicator of age-related elastin and collagen changes in Bruch's membrane) and systolic blood pressure with an increased 10-year incidence of some lesions defining early age-related maculopathy and exudative macular degeneration.
研究心血管疾病及其危险因素与年龄相关性黄斑病变10年发病率之间的关联。
基于人群的队列研究。
1988年至1990年基线检查时年龄在43至86岁之间，居住在威斯康星州比弗代尔的人群，其中3684人参加了为期5年的随访检查，2764人参加了为期10年的随访检查。
采用标准化方案进行体格检查、血液采集、问卷调查以及立体彩色眼底照相，以确定年龄相关性黄斑病变。数据分析采用Kaplan-Meier（乘积限）生存法和离散线性逻辑回归。
年龄相关性黄斑病变的发病率和进展情况。
在对年龄、性别、大量饮酒史、吸烟史和维生素使用情况进行控制后，基线收缩压较高与视网膜色素上皮色素脱失的10年发病率相关（每10 mmHg收缩压的风险比[RR]为1.10；95%置信区间[CI]为1.01 - 1.18；P = 0.02）以及渗出性黄斑变性相关（RR为1.22；95% CI为1.06 - 1.41；P = 0.006）。基线脉压较高与视网膜色素上皮色素脱失的发病率相关（每10 mmHg的RR为1.17；95% CI为1.07 - 1.28；P < 0.001）、视网膜色素增加（RR为1.10；95% CI为1.01 - 1.19；P = 0.03）、渗出性黄斑变性（RR为1.34；95% CI为1.14 - 1.60；P < 0.001）以及年龄相关性黄斑病变的进展相关（RR为1.08；95% CI为1.01 - 1.17；P = 0.03）。基线血清高密度脂蛋白胆固醇较高与单纯性地图状萎缩相关（每10 mg/dl高密度脂蛋白胆固醇的RR为1.29；95% CI为1.05 - 1.58；P = 0.01）。基线体力活动与地图状萎缩的发病率相关（每周出汗5次者与不出汗者相比的RR为0.12；95% CI为0.02 - 0.91；P = 0.04）、渗出性黄斑变性相关（RR为0.27；95% CI为0.08 - 0.87；P = 0.05）以及年龄相关性黄斑病变的进展相关（RR为0.69；95% CI为0.47 - 1.00；P = 0.05）。中风史和心脏病发作史均与年龄相关性黄斑病变的发病率或进展无关。
这些发现表明较高的脉压（推测为布鲁赫膜中与年龄相关的弹性蛋白和胶原蛋白变化的指标）和收缩压与某些定义早期年龄相关性黄斑病变和渗出性黄斑变性的病变10年发病率增加之间存在关联。
