van Leeuwen Redmer, Ikram M Kamran, Vingerling Johannes R, Witteman Jacqueline C M, Hofman Albert, de Jong Paulus T V M
Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
Invest Ophthalmol Vis Sci. 2003 Sep;44(9):3771-7. doi: 10.1167/iovs.03-0121.
To determine whether blood pressure and subclinical atherosclerosis are associated with incident age-related maculopathy (ARM).
The study was performed within the Rotterdam Study, a population-based, prospective cohort study in Rotterdam, The Netherlands. A total of 4822 subjects who at baseline were aged 55 years more, were free of ARM, and participated in at least one of two follow-up examinations after a mean of 2 and 6.5 years, were included in the study. At baseline, blood pressure and the presence of atherosclerosis were determined. ARM was assessed according to the International Classification and Grading System and defined as large, soft drusen with pigmentary changes; indistinct drusen; or atrophic or neovascular age-related macular degeneration.
After a mean follow-up of 5.2 years, incident ARM was diagnosed in 417 subjects. Increased systolic blood pressure or pulse pressure was associated with a higher risk of ARM. Adjusted for age, gender, smoking, total and high-density lipoprotein cholesterol, body mass index, and diabetes mellitus, odds ratios (OR) per 10-mm Hg increase were 1.08 (95% confidence interval [CI]: 1.03-1.14) and 1.11 (95% CI: 1.04-1.18), respectively. Moreover, different measures of atherosclerosis were associated with the risk of ARM. An increase in carotid wall thickness (OR per 1 SD, 1.15; 95% CI: 1.03-1.28) increased the risk of ARM. The lowest compared with the highest tertile of ankle-arm index had an OR of 1.32 (95% CI: 1.00-1.75). A weak association was found between aortic calcifications and the risk of ARM.
Elevated systolic blood or pulse pressure or the presence of atherosclerosis may increase the risk of development of ARM.
确定血压和亚临床动脉粥样硬化是否与年龄相关性黄斑病变（ARM）的发生有关。
该研究在荷兰鹿特丹进行的基于人群的前瞻性队列研究——鹿特丹研究中开展。共有4822名基线年龄在55岁及以上、无ARM且在平均2年和6.5年后参加了至少两次随访检查之一的受试者纳入研究。在基线时，测定血压和动脉粥样硬化情况。根据国际分类和分级系统评估ARM，定义为伴有色素改变的大的软性玻璃膜疣；不明确的玻璃膜疣；或萎缩性或新生血管性年龄相关性黄斑变性。
平均随访5.2年后，417名受试者被诊断为发生了ARM。收缩压或脉压升高与ARM风险较高相关。在调整年龄、性别、吸烟、总胆固醇和高密度脂蛋白胆固醇、体重指数和糖尿病后，每升高10 mmHg的比值比（OR）分别为1.08（95%置信区间[CI]：1.03 - 1.14）和1.11（95% CI：1.04 - 1.18）。此外，不同的动脉粥样硬化测量指标与ARM风险相关。颈动脉壁厚度增加（每增加1个标准差的OR为1.15；95% CI：1.03 - 1.28）会增加ARM风险。与最高三分位数相比，最低三分位数的踝臂指数的OR为1.32（95% CI：1.00 - 1.75）。发现主动脉钙化与ARM风险之间存在弱关联。
收缩压或脉压升高或存在动脉粥样硬化可能会增加ARM发生的风险。
