McGuinness Myra B, Karahalios Amalia, Finger Robert P, Guymer Robyn H, Simpson Julie A
a Centre for Eye Research Australia , Royal Victorian Eye and Ear Hospital , East Melbourne , Australia.
b Department of Ophthalmology , University of Melbourne , East Melbourne , Australia.
Ophthalmic Epidemiol. 2017 Jun;24(3):141-152. doi: 10.1080/09286586.2016.1259422. Epub 2017 Jan 31.
Age-related macular degeneration (AMD) is the leading cause of severe, irreversible vision loss in older adults. Evidence for an association between AMD and mortality remains inconclusive despite evidence for an association with cardiovascular and inflammatory diseases. We aim to compare all-cause, cardiovascular and cancer mortality between those with early or late AMD and control study participants.
A protocol was registered at PROSPERO (CRD42015020622). A systematic search of Medline (Ovid), PubMed, and Embase (Ovid) was conducted on 6 June 2015. Reference lists from identified studies and four clinical trial registries were searched for additional studies. Participants were required to be over the age of 40 years, and AMD status must have been objectively assessed. The Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool was used to assess the risk of bias. Random-effects meta-analyses were performed.
A total of 12 reports from 10 studies were included in the meta-analysis. Late AMD was associated with elevated rates of all-cause (nine studies, hazard ratio (HR) 1.20, 95% confidence interval, CI, 1.02-1.41) and cardiovascular mortality (six studies, HR 1.46, 95% CI 1.13-1.98), but early AMD was not (all-cause mortality, 10 studies, HR 1.06, 95% CI 0.98-1.14; cardiovascular mortality, five studies, HR 1.12, 95% CI 0.96-1.31). There was no evidence of an association between early or late AMD and cancer mortality (early AMD, three studies, HR 1.17, 95% CI 0.78-1.75; late AMD, three studies, HR 1.01, 95% CI 0.77-1.33).
Late AMD is associated with increased rates of all-cause and cardiovascular mortality, suggesting shared pathways between late AMD and systemic disease.
年龄相关性黄斑变性（AMD）是老年人严重、不可逆视力丧失的主要原因。尽管有证据表明AMD与心血管疾病和炎症性疾病有关，但AMD与死亡率之间关联的证据仍不确凿。我们旨在比较早期或晚期AMD患者与对照研究参与者的全因死亡率、心血管疾病死亡率和癌症死亡率。
一项方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42015020622）登记。2015年6月6日对Medline（Ovid）、PubMed和Embase（Ovid）进行了系统检索。检索了已识别研究的参考文献列表和四个临床试验注册库以查找其他研究。参与者需年龄超过40岁，且AMD状态必须经过客观评估。使用非随机干预性研究的偏倚风险（ROBINS-I）工具评估偏倚风险。进行随机效应荟萃分析。
荟萃分析纳入了来自10项研究的共12份报告。晚期AMD与全因死亡率（9项研究，风险比（HR）1.20，95%置信区间（CI）为1.02 - 1.41）和心血管疾病死亡率（6项研究，HR 1.46，95% CI 1.13 - 1.98）升高相关，但早期AMD并非如此（全因死亡率，10项研究，HR 1.06，95% CI 0.98 - 1.14；心血管疾病死亡率，5项研究，HR 1.12，95% CI 0.96 - 1.31）。没有证据表明早期或晚期AMD与癌症死亡率之间存在关联（早期AMD，3项研究，HR 1.17，95% CI 0.78 - 1.75；晚期AMD，3项研究，HR 1.01，95% CI 0.77 - 1.33）。
晚期AMD与全因死亡率和心血管疾病死亡率升高相关，提示晚期AMD与全身性疾病之间存在共同途径。
