Lee Wan-Ju Annabelle, Cheng Ching-Lan, Lee Cheng-Han, Kao Yang Yea-Huei, Lin Swu-Jane, Hsieh Cheng-Yang
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
School of Pharmacy, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
Pharmacoepidemiol Drug Saf. 2017 Oct;26(10):1277-1285. doi: 10.1002/pds.4299. Epub 2017 Aug 30.
Age-related macular degeneration (AMD) is an eye disease causing blindness in the elderly. It shares many common possible pathogenic mechanisms with cardiovascular diseases. Many studies have discussed the association between AMD and stroke, but the results were inconsistent. Our aim was to determine the associations between neovascular AMD and the risk of stroke in the Taiwanese population.
This is a retrospective cohort study. We used claims data from National Health Insurance Research Database. Patients aged more than 45 years without stroke, myocardial infarction, or any AMD were selected from 2001 to 2008 and followed until 2010. The index date was defined as the date of nAMD diagnosis (ICD-9 code, 362.52). The comparison group was patients without an nAMD diagnosis with age- and sex-matched to nAMD subjects at a ratio of up to 10 to 1. Kaplan-Meier survival analysis and Cox regression analysis were used. The incidence of stroke events (ICD-9 codes, 430-434) and their subtypes (hemorrhagic and ischemic) were primary outcomes. Secondary outcomes included acute myocardial infarction (AMI), composite AMI/stroke, and all-cause mortality.
Patients with nAMD had a higher risk of developing stroke, with an adjusted HR of 1.30 (95% CI, 1.01-1.68). A higher risk for hemorrhagic stroke (HR, 1.70, 95% CI, 1.03-2.83) was also found. No significant differences were observed in ischemic stroke, the composite of AMI/stroke, and all-cause mortality.
Patients with nAMD had a significantly higher risk of developing stroke, which was driven mainly by the increased risk of developing the hemorrhagic subtype.
年龄相关性黄斑变性（AMD）是一种导致老年人失明的眼部疾病。它与心血管疾病有许多共同的可能致病机制。许多研究讨论了AMD与中风之间的关联，但结果并不一致。我们的目的是确定台湾人群中新生血管性AMD与中风风险之间的关联。
这是一项回顾性队列研究。我们使用了国民健康保险研究数据库中的理赔数据。从2001年至2008年选取年龄超过45岁、无中风、心肌梗死或任何AMD的患者，并随访至2010年。索引日期定义为新生血管性AMD诊断日期（国际疾病分类第九版代码，362.52）。对照组为未诊断为新生血管性AMD的患者，年龄和性别与新生血管性AMD受试者匹配，比例最高为10比1。采用Kaplan-Meier生存分析和Cox回归分析。中风事件（国际疾病分类第九版代码，430 - 434）及其亚型（出血性和缺血性）的发生率是主要结局。次要结局包括急性心肌梗死（AMI）、AMI/中风复合事件和全因死亡率。
新生血管性AMD患者发生中风的风险更高，调整后的风险比为1.30（95%置信区间，1.01 - 1.68）。还发现出血性中风的风险更高（风险比，1.70，95%置信区间，1.03 - 2.83）。在缺血性中风、AMI/中风复合事件和全因死亡率方面未观察到显著差异。
新生血管性AMD患者发生中风的风险显著更高，这主要是由出血性亚型风险增加所致。
