心血管健康的新指标及其与年龄相关性黄斑变性患病率和进展的关联：CHARM研究
Novel measures of cardiovascular health and its association with prevalence and progression of age-related macular degeneration: the CHARM Study.
作者信息
McCarty Catherine A, Dowrick Adam, Cameron James, McGrath Barry, Robman Luba D, Dimitrov Peter, Tikellis Gabriella, Nicolas Caroline, McNeil John, Guymer Robyn
机构信息
Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, MA, USA.
出版信息
BMC Ophthalmol. 2008 Dec 22;8:25. doi: 10.1186/1471-2415-8-25.
BACKGROUND
To determine if novel measures of cardiovascular health are associated with prevalence or progression of age-related macular degeneration (AMD).
METHODS
Measures of the cardiovascular system: included intima media thickness (IMT), pulse wave velocity (PWV), systemic arterial compliance (SAC), carotid augmentation index (AI). For the prevalence study, hospital-based AMD cases and population-based age- and gender-matched controls with no signs of AMD in either eye were enrolled. For the progression component, participants with early AMD were recruited from two previous studies; cases were defined as progression in one or both eyes and controls were defined as no progression in either eye.
RESULTS
160 cases and 160 controls were included in the prevalence component. The upper two quartiles of SAC, implying good cardiovascular health, were significantly associated with increased risk of AMD (OR = 2.54, 95% CL = 1.29, 4.99). High PWV was associated with increased prevalent AMD. Progression was observed in 82 (32.3%) of the 254 subjects recruited for the progression component. Higher AI (worse cardiovascular function) was protective for AMD progression (OR = 0.30, 95%CL = 0.13, 0.69). Higher aortic PWV was associated with increased risk of AMD progression; the highest risk was seen with the second lowest velocity (OR = 6.22, 95% CL = 2.35, 16.46).
CONCLUSION
The results were unexpected in that better cardiovascular health was associated with increased risk of prevalent AMD and progression. Inconsistent findings between the prevalence and progression components could be due to truly different disease etiologies or to spurious findings, as can occur with inherent biases in case control studies of prevalence. Further investigation of these non-invasive methods of characterizing the cardiovascular system should be undertaken as they may help to further elucidate the role of the cardiovascular system in the etiology of prevalent AMD and progression.
背景
确定心血管健康的新指标是否与年龄相关性黄斑变性（AMD）的患病率或病情进展相关。
方法
心血管系统指标包括内膜中层厚度（IMT）、脉搏波速度（PWV）、全身动脉顺应性（SAC）、颈动脉增强指数（AI）。在患病率研究中，纳入了以医院为基础的AMD病例以及以人群为基础的年龄和性别匹配的对照，这些对照双眼均无AMD迹象。在病情进展部分，早期AMD参与者来自之前的两项研究；病例定义为一只或两只眼睛病情进展，对照定义为两只眼睛均无病情进展。
结果
患病率部分纳入了160例病例和160例对照。SAC的上两个四分位数意味着良好的心血管健康，与AMD风险增加显著相关（OR = 2.54，95%CI = 1.29，4.99）。高PWV与AMD患病率增加相关。在病情进展部分招募的254名受试者中，有82名（32.3%）出现病情进展。较高的AI（较差的心血管功能）对AMD病情进展具有保护作用（OR = 0.30，95%CI = 0.13，0.69）。较高的主动脉PWV与AMD病情进展风险增加相关；风险最高的是速度第二低的情况（OR = 6.22，95%CI = 2.35，16.46）。
结论
结果出乎意料，因为更好的心血管健康与AMD患病率和病情进展风险增加相关。患病率和病情进展部分结果不一致可能是由于真正不同的疾病病因，也可能是由于虚假结果，如患病率病例对照研究中固有的偏差所导致。应进一步研究这些用于表征心血管系统的非侵入性方法，因为它们可能有助于进一步阐明心血管系统在AMD患病率和病情进展病因中的作用。
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