IMPORTANCE Despite strong biological plausibility, evidence from epidemiologic studies and clinical trials on the relations between intakes of lutein and zeaxanthin and age-related macular degeneration (AMD) has been inconsistent. The roles of other carotenoids are less thoroughly investigated.OBJECTIVE To investigate the associations between intakes of carotenoids and AMD.

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Objectives To evaluate the associations between intakes of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the intermediate and advanced stages of age-related macular degeneration (AMD). Design Prospective cohort study. Participants We followed 75,889 women from the Nurses’ Health Study and 38,961 men from the Health Professionals Follow-Up Study who were at least 50 years old from 1984 to 2012 and 1986 to 2010, respectively. Cohort participants are mostly white (≥ 95%). Methods We assessed dietary intake by a validated food frequency questionnaire (FFQ) at baseline and every four years. We calculated cumulative average intakes of EPA and DHA from FFQs and also computed predicted erythrocyte and plasma scores directly from food intake using regression models. Cox proportional hazards models were used to compute the associations with AMD outcomes. Main Outcome Measures We confirmed 1,589 incident intermediate and 1,356 advanced AMD cases (primarily neovascular AMD) with a visual acuity of 20/30 or worse due primarily to AMD by medical record review. Results For intermediate AMD, the pooled hazard ratio (HR) between the two cohorts for DHA comparing the extreme quintiles of intake was 0.78 (95% CI, 0.66 – 0.92; p trend, 0.008) and for EPA + DHA was 0.83 (95% CI, 0.71 – 0.98; p trend, 0.03). The pooled HR for fatty fish comparing ≥ 5 servings/week to almost never was 0.61 (95% CI, 0.46 – 0.81; p trend, < 0.001). For advanced AMD, the pooled HR for DHA was 1.01 (95% CI, 0.84 – 1.21; p trend, 0.75) and for fatty fish was 0.80 (95% CI, 0.59 – 1.08; p trend, 0.11). Secondary analyses using predicted erythrocyte and plasma scores of EPA and DHA yielded slightly stronger inverse associations for intermediate AMD and similar results for advanced AMD. Conclusions Higher intakes of EPA and DHA may prevent or delay the occurrence of visually significant intermediate AMD. However, the totality of current evidence for EPA and DHA and advanced AMD is discordant, though there was no association with advanced AMD in the present study.

ImportanceResearch has indicated some shared pathogenic mechanisms between age-related macular degeneration (AMD) and cardiovascular disease (CVD). However, results from prior epidemiologic studies have been inconsistent as to whether AMD is predictive of future CVD risk.ObjectiveTo systematically review population-based cohort studies of the association between AMD and risk of total CVD and CVD subtypes, coronary heart disease (CHD) and stroke.Data SourcesA systematic search of the PubMed and EMBASE databases and reference lists of key retrieved articles up to December 20, 2012 without language restriction.Data ExtractionTwo reviewers independently extracted data on baseline AMD status, risk estimates of CVD and methods used to assess AMD and CVD. We pooled relative risks using random or fixed effects models as appropriate.ResultsThirteen cohort studies (8 prospective and 5 retrospective studies) with a total of 1,593,390 participants with 155,500 CVD events (92,039 stroke and 62,737 CHD) were included in this meta-analysis. Among all studies, early AMD was associated with a 15% (95% CI, 1.08–1.22) increased risk of total CVD. The relative risk was similar but not significant for late AMD (RR, 1.17; 95% CI, 0.98–1.40). In analyses restricted to the subset of prospective studies, the risk associated with early AMD did not appreciably change; however, there was a marked 66% (95% CI, 1.31–2.10) increased risk of CVD among those with late AMD.ConclusionWhereas the results from all cohort studies suggest that both early and late AMD are predictive of a small increase in risk of future CVD, subgroup analyses limited to prospective studies demonstrate a markedly increased risk of CVD among people with late AMD. Retrospective studies using healthcare databases may have inherent methodological limitations that obscure such association. Additional prospective studies are needed to further elucidate the associations between AMD and specific CVD outcomes.