动脉粥样硬化与年龄相关性黄斑变性 10 年累积发病率的关系：比弗大坝研究。
The relationship of atherosclerosis to the 10-year cumulative incidence of age-related macular degeneration: the Beaver Dam studies.
机构信息
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53726, USA.
出版信息
Ophthalmology. 2013 May;120(5):1012-9. doi: 10.1016/j.ophtha.2012.11.003. Epub 2013 Feb 8.
OBJECTIVE
To describe the relationships of intima-media thickness (IMT), plaque in the carotid artery, angina, myocardial infarction (MI), and stroke to the 10-year cumulative incidence of early and late age-related macular degeneration (AMD) and progression of AMD.
DESIGN
Cohort study.
PARTICIPANTS
A total of 1700 persons aged 53 to 96 years who participated in both the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study in 1998-2000, with photographs gradable for AMD at 5-year (2003-2005) and 10-year (2008-2010) follow-up examinations.
METHODS
The IMT and presence of plaque were assessed using B-mode ultrasonography of the carotid artery. Presence of angina, MI, and stroke were defined on the basis of a self-reported history of physician diagnosis. The presence and severity of AMD were determined by systematic grading of stereoscopic color fundus photographs.
MAIN OUTCOME MEASURES
Age-related macular degeneration.
RESULTS
The 10-year cumulative incidence of early AMD was 15.7%, and the 10-year cumulative incidence of late AMD was 4.0%. After adjusting for age, sex, body mass index, smoking status, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) genotypes, and other factors, mean IMT was associated with the 10-year incidence of early AMD (odds ratio [OR] per 0.1 mm IMT, 1.11; 95% confidence interval [CI], 1.00-1.21; P = 0.03) and late AMD (OR per 0.1 mm IMT, 1.27; CI, 1.10-1.47; P = 0.001). Mean IMT was associated with the 10-year incidence of pure geographic atrophy (OR per 0.1 mm IMT, 1.31; CI, 1.05-1.64; P = 0.02) but not exudative AMD (OR per 0.1 mm IMT, 1.14; CI, 0.97-1.34; P = 0.11). Similar associations were found for maximum IMT. The number of sites with plaque was related to the incidence of late AMD (OR per 0.1 mm IMT, 2.79 for 4-6 sites vs. none; CI, 1.06-7.37; P = 0.04) but not to early AMD. A history of angina, MI, or stroke was not related to any incident AMD outcome.
CONCLUSIONS
In these population-based data, carotid artery IMT and carotid plaques had a weak relationship to the incidence of late AMD that was independent of systemic and genetic risk factors. Angina, MI, and stroke were not related to AMD. It is unclear whether the carotid IMT is a risk indicator of processes affecting Bruch's membrane and the retinal pigment epithelium, or a measure of atherosclerosis affecting susceptibility to AMD.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
目的
描述内-中膜厚度（IMT）、颈动脉斑块、心绞痛、心肌梗死（MI）和中风与早发性和迟发性年龄相关性黄斑变性（AMD）的 10 年累积发生率以及 AMD 进展之间的关系。
设计
队列研究。
参与者
共有 1700 名年龄在 53 至 96 岁之间的人参加了 1998-2000 年的听力损失研究和比佛达姆眼研究，他们在 5 年（2003-2005 年）和 10 年（2008-2010 年）随访检查中接受了 AMD 的分级摄影。
方法
使用颈动脉 B 型超声评估 IMT 和斑块的存在。心绞痛、MI 和中风的存在是基于医生诊断的自我报告病史来确定的。AMD 的存在和严重程度是通过系统分级的立体彩色眼底照片来确定的。
主要观察指标
年龄相关性黄斑变性。
结果
早发性 AMD 的 10 年累积发生率为 15.7%，迟发性 AMD 的 10 年累积发生率为 4.0%。在调整年龄、性别、体重指数、吸烟状况、年龄相关性黄斑病变易感性 2（ARMS2）和补体因子 H（CFH）基因型以及其他因素后，平均 IMT 与早发性 AMD 的 10 年发病率相关（每 0.1mm IMT 的比值比 [OR]，1.11；95%置信区间 [CI]，1.00-1.21；P=0.03）和迟发性 AMD（每 0.1mm IMT 的 OR，1.27；CI，1.10-1.47；P=0.001）。平均 IMT 与 10 年纯地理萎缩（每 0.1mm IMT 的 OR，1.31；CI，1.05-1.64；P=0.02）的 10 年发生率相关，但与渗出性 AMD 无关（每 0.1mm IMT 的 OR，1.14；CI，0.97-1.34；P=0.11）。最大 IMT 也存在类似的关联。斑块数量与迟发性 AMD 的发生率有关（每 0.1mm IMT 的 OR，4-6 个部位与无部位相比为 2.79；CI，1.06-7.37；P=0.04），但与早发性 AMD 无关。心绞痛、MI 或中风的病史与任何 AMD 事件均无关。
结论
在这些基于人群的数据中，颈动脉 IMT 和颈动脉斑块与迟发性 AMD 的发生率之间存在微弱的关系，这种关系独立于全身和遗传危险因素。心绞痛、MI 和中风与 AMD 无关。尚不清楚颈动脉 IMT 是影响 Bruch 膜和视网膜色素上皮的过程的风险指标，还是影响 AMD 易感性的动脉粥样硬化的衡量指标。
财政披露
作者没有与本文讨论的任何材料有关的专有或商业利益。
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