Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Asia Pac J Ophthalmol (Phila). 2023;12(3):293-302. doi: 10.1097/APO.0000000000000612. Epub 2023 May 31.
Major risk factors of atherosclerotic cardiovascular disease (ASCVD) and mortality have been well-established in the general population. Our study is aimed at assessing longitudinal relationships between ASCVD risk factors and incident ASCVD events or all-cause mortality in patients with age-related macular degeneration (AMD).
Multivariable-adjusted Cox proportional hazards models were used to study the association between cardiovascular risk factors with adjudicated incident ASCVD events and all-cause mortality outcomes followed until 2021. A restricted cubic spline approach was utilized to assess nonlinear associations between potential cardiovascular risk factors and ASCVD or mortality.
We identified 3508 eligible patients [mean (SD) age = 61.45 (6.43) years; 37.76% males] with AMD at baseline. During a median follow-up year of 12, there were 110 cases of ASCVD events and 186 cases of all-cause mortality. After multivariable adjustment, each 10 U/L increase of serum gamma-glutamyl transferase level was linearly associated with incident ASCVD [hazard ratio (HR) = 1.03, 95% CI = 1.00-1.07, Pnonlinear = 0.85)] in AMD. A history of chronic kidney disease (HR = 1.94, 95% CI = 1.09-3.46) and lower vitamin D [HR = 0.98, 95% CI = 0.97-0.99, per nanomoles per liter (nmol/L)] were significantly associated with all-cause mortality in patients with AMD, with the association between vitamin D and all-cause mortality presenting a U shape (Pnonlinear = 0.02). In contrast, risk factors significantly associated with ASCVD and all-cause mortality in healthy controls differed from patients with AMD.
Our findings demonstrate risk factors associated with ASCVD events and all-cause mortality among individuals with AMD differed from healthy controls and suggest the long-term management of risk factors in patients with AMD.
在一般人群中，动脉粥样硬化性心血管疾病（ASCVD）和死亡率的主要危险因素已得到充分确立。我们的研究旨在评估年龄相关性黄斑变性（AMD）患者 ASCVD 风险因素与 ASCVD 事件或全因死亡率之间的纵向关系。
使用多变量调整的 Cox 比例风险模型研究心血管危险因素与裁定的 ASCVD 事件和全因死亡率结局之间的关联，随访至 2021 年。采用限制性三次样条方法评估潜在心血管危险因素与 ASCVD 或死亡率之间的非线性关系。
我们确定了 3508 名符合条件的 AMD 患者[平均（SD）年龄=61.45（6.43）岁；37.76%为男性]。在中位 12 年的随访期间，有 110 例 ASCVD 事件和 186 例全因死亡。经过多变量调整后，血清γ-谷氨酰转移酶水平每增加 10U/L，与 AMD 患者的 ASCVD 事件呈线性相关[风险比（HR）=1.03，95%置信区间（CI）=1.00-1.07，P 非线性=0.85)]。慢性肾脏病史（HR=1.94，95%CI=1.09-3.46）和较低的维生素 D[HR=0.98，95%CI=0.97-0.99，每纳摩尔/升（nmol/L）]与 AMD 患者的全因死亡率显著相关，维生素 D 与全因死亡率之间呈 U 型关系（P 非线性=0.02）。相比之下，与健康对照组相比，与 AMD 患者 ASCVD 和全因死亡率显著相关的风险因素有所不同。
我们的研究结果表明，AMD 患者 ASCVD 事件和全因死亡率相关的危险因素与健康对照组不同，提示 AMD 患者应长期管理危险因素。
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