Tan J S L, Wang J J, Liew G, Rochtchina E, Mitchell P
Centre for Vision Research, Department of Ophthalmology, University of Sydney, Westmead Hospital, Hawkesbury Rd, Westmead, NSW Australia.
Br J Ophthalmol. 2008 Apr;92(4):509-12. doi: 10.1136/bjo.2007.131706. Epub 2008 Feb 29.
BACKGROUND/AIMS: Age-related macular degeneration (AMD) and vascular disease share similar risk factors. Recent data suggest AMD may independently predict stroke or coronary heart disease. We prospectively assessed the relationship between AMD and risk of stroke- or cardiovascular-related death in an Australian population.
Of 3654 baseline participants (1992-4) aged 49+ years, 2335 were re-examined after 5 years and 1952 after 10 years. Retinal photographs were graded using the Wisconsin System. History and physical examination provided data on possible risk factors. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Risk ratios (RR) were estimated in Cox models.
Among persons aged <75 years at baseline, early AMD predicted a doubling of cardiovascular mortality (RR, 2.32; 95% confidence interval (CI), 1.03 to 5.19), over the next decade, after controlling for traditional cardiovascular risk factors. Late AMD predicted fivefold higher cardiovascular mortality (RR, 5.57; 95% CI, 1.35 to 22.99) and 10-fold higher stroke mortality (RR, 10.21; 95% CI, 2.39 to 43.60) after adjusting for age and sex only. These associations were not present when persons older than 75 were included.
AMD predicted stroke and cardiovascular events over the long term in persons aged 49-75 years. This may have potential implications for new intravitreal anti-VEGF AMD therapies.
背景/目的：年龄相关性黄斑变性（AMD）与血管疾病具有相似的危险因素。近期数据表明，AMD可能独立预测中风或冠心病。我们前瞻性评估了澳大利亚人群中AMD与中风或心血管相关死亡风险之间的关系。
在3654名年龄≥49岁的基线参与者（1992 - 1994年）中，2335人在5年后接受复查，1952人在10年后接受复查。视网膜照片采用威斯康星系统进行分级。病史和体格检查提供了可能的危险因素数据。通过与澳大利亚国家死亡指数的数据链接确认死亡情况和死因。在Cox模型中估计风险比（RR）。
在基线年龄<75岁的人群中，在控制传统心血管危险因素后，早期AMD预测未来十年心血管死亡率增加一倍（RR，2.32；95%置信区间（CI），1.03至5.19）。仅校正年龄和性别后，晚期AMD预测心血管死亡率高5倍（RR，5.57；95% CI，1.35至22.99），中风死亡率高10倍（RR，10.21；95% CI，2.39至43.60）。纳入75岁以上人群后，这些关联不存在。
AMD在49 - 75岁人群中长期预测中风和心血管事件。这可能对新的玻璃体内抗VEGF AMD治疗有潜在影响。
