Cardiovascular risk factors associated with age‐related macular degeneration: the Tromsø Study

Abstract

ABSTRACT.Purpose: To examine associations between cardiovascular risk factors and agerelated macular degeneration (AMD). Methods: A population-based, cross-sectional study of Caucasians aged 65-87 years was conducted in Norway in 2007/2008. Retinal photographs were graded for AMD. Multivariable logistic regression analyses were performed based on questionnaires addressing habits of smoking, alcohol consumption, physical activity, health and medication; and physical examination comprising anthropometric measurements, blood pressure and blood sampling. Cardiovascular disease status was obtained from a validated end-point registry.Results: Gradable photographs were available for 2631 participants, of whom 92 (3.5%) subjects had late AMD. In the multivariable analysis of late AMD, significant interactions were found between sex and the variables age, triglyceride level, use of lipid-lowering drugs and physical exercise. Current daily smoking was significantly related to late AMD in both sexes (odds ratio (OR) 4.06, 95% confidence interval (CI) 1.69-9.76 and OR 3.59, 95% CI 1.17-11.04, women and men, respectively) compared with never smokers. Higher number of pack years was associated with the presence of large drusen (>125 lm) (OR 1.04, 95% CI 1.01-1.09 per 5 years). Higher systolic blood pressure (OR 1.06, 95% CI 1.01-1.12 per 5 mmHg), overweight (OR 2.87, 95% CI 1.13-7.29) and obesity (OR 2.92, 95% CI 1.06-8.03), physical exercise duration (OR 0.41, 95% 0.18-0.96 for 30 min or more compared with less) and frequency (OR 0.46, 95% CI 0.23-0.92 for weekly or more often compared to less) were associated with late AMD in women only. Conclusions: Smoking was strongly associated with AMD, in line with results from other populations. Also, late AMD was related to higher systolic blood pressure, physical inactivity, overweight and obesity in women.

Essential hypertension in the pathogenesis of age-related macular degeneration

“…In the Tromsø study, a population-based, cross-sectional study of Caucasians aged 65-87 years conducted in Norway in 2007/2008, late AMD was found to be related to higher systolic blood pressure in women only, as were other factors associated with hypertension, such as physical inactivity, overweight and obesity [43]. In prospective studies, increased blood pressure has been found to be associated with incident AMD [44].…”

“…Furthermore, from a substudy that investigated the association between a history of vasodilator and blood pressure-lowering drug use and the incidence and progression of early and late AMD, it emerged that oral nitroglycerin (HR, 1.81; 95% CI, 1.14-2.90) was associated with an increased risk of early AMD, whereas oral b-blocking agents treatment was associated with an increased risk of incident exudative AMD [hazard ratio (HR), 1.71; 95% CI, 1.04-2.82], but not pure geographic atrophy (HR, 0.51; 95% CI, 0.20-1.29) or AMD progression (HR, 0.92; 95% CI, 0.67-1.28) over a 20-year period Table 2 [33,34,37,38,40,41,[43][44][45][46][47][48][49][50]58]. The mechanisms leading to the above observations are not easy to understand, especially when we consider that vasoconstriction of the retinal and choroidal vessels seems to be involved in the pathogenesis of AMD, while vasodilators have been used to resolve the vasoconstriction.…”

“…No association for HTN, SBP or DBP. Cheung et al [40] Cross-sectional, population-based 10 033 n/a Early AMD: positive correlated with HTN late AMD: no correlation with HTN Erke et al [43] Cross-sectional, population-based 2631 n/a Late AMD was found to be related to higher SBP in women only Yang et al [45] Cross-sectional, population-based 6577 n/a Untreated HTN associated with an increased risk of early AMD Park et al [46] Cross-sectional, population-based 14 352 n/a No correlation of HTN with AMD Sandra et al [49] Meta-analysis 9523 6 No evidence to support a significant association between AMD and hypertension Chakravarthy et al [33] Meta-analysis 94 058 n/a OR inconsistent across studies, but the pooled estimate for case-control studies was statistically significant for hypertension (OR, 1.48; 95% CI 1.22-1.78) AMD, age-macular degeneration; HTN, hypertension; NV, neovascular; OR, odds ratio; PP, pulse pressure; SBP, systolic blood pressure.…”

Risk Factors and Age-Related Macular Degeneration in a Mediterranean-Basin Population: The PAMDI (Prevalence of Age-Related Macular Degeneration in Italy) Study - Report 2

“…Though its complete aetiology and pathogenesis are yet to be clarified, it might be possible to alter the prevalence and incidence of ARMD by acting on modifiable risk factors [29], despite a given genetic background [30], by modifying specific habits such as smoking and dietary intake of antioxidants [21]. …”

Clinical Characteristics of Familial and Sporadic Age-Related Macular Degeneration: Differences and Similarities

“…Advanced age, female sex, smoking, and obesity (body mass index [BMI] > 30) are most commonly reported as important demographic and environmental risk factors for the development of AMD. [1][2][3][4][5][6] In addition, several important genetic variants have been found to be associated with AMD, either as a risk factor or as a protective factor. The strongest associations have been reported for the singlenucleotide polymorphisms (SNPs) in the complement factor H gene (CFH Y402H; rs1061170), and in the age-related maculopathy susceptibility 2 gene (ARMS2 A69S; rs10490924), which strongly increase the risk of developing AMD.…”