Age-Related Macular Degeneration and the Incidence of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Abstract

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.

Genomic aspects of age-related macular degeneration

“…192 Human histopathological studies suggest that M2 macrophages 193 are likely activated in later AMD stages rather than in early stages 194 [35,36]. Thus, immune responses evoked by drusen-induced 195 inflammation likely play a central role in the pathogenesis of 196 AMD. The mechanism seems has many similarities with that of 197 atherosclerosis.…”

“…[195]. A systematic review and meta-analysis of 773 population-based cohort studies suggest that early AMD was asso-774 ciated with a future risk of CVD events, including coronary heart 775 disease and stroke [196]. C-reactive protein (CRP) is an inflamma-776 tory marker known for the association with cardiovascular disease.…”

Epidemiology of age-related macular degeneration (AMD): associations with cardiovascular disease phenotypes and lipid factors

“…The baseline presence of AMD did not predict occurrence of CHD or CVD in the Multi-Ethnic Study of Atherosclerosis (MESA, [123]) full population, but late AMD did associate with both CVD and CHD in a subgroup comprised of older (65+) white participants. In a meta-analysis published in 2014 of eight prospective and five retrospective studies, Wu et al [124] reported that patients with early AMD had an increased risk for CVD and for CHD. When they narrowed the analysis to include only the prospective studies, they also observed that subjects with late AMD had an increased risk for CVD.…”

The age-related macular degeneration as a vascular disease/part of systemic vasculopathy: contributions to its pathogenesis

“…Az -intervencióra szorult, illetve azon átesett -ischaemiás szívbetegségben szenvedők 22%-ában alakult ki AMD. A korai és késői AMD az elkövetkező cardiovascularis betegség független előrejelzője, az összefüggés sokkal erősebb a késői AMD esetében [74].…”