Relation between Age-Related Macular Degeneration and Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis

Abstract

Data on the association between age-related macular degeneration (AMD) and cardiovascular disease and mortality are conflicting. The purpose of this report is to conduct a systematic review to better understand the role of AMD as a risk factor for CVD events and mortality. We searched Medline (Ovid) and Embase (Ovid) for trials published from 1980 to 2015. We included 20 cohort studies that reported relative risks with 95% confidence intervals for the association of AMD and cardiovascular events and mortality, involving 29,964,334 participants. In a random-effects model, the adjusted RR (95% confidence interval [CI]) associated with AMD was 1.08 (1.00–1.117) for all-cause mortality (8 studies) and 1.18 (0.98–1.43) for cardiovascular disease mortality (5 studies). The pooled RR (95% CI) was 1.17 (0.94–1.45) for coronary heart disease (CHD; 3 studies) and 1.13 (0.93–1.36) for stroke (8 studies). Findings from this systematic review support that AMD is associated with increased risk of all-cause mortality. The evidence that AMD predicts incident CVD events or CVD mortality remains inclusive and warrants further study in the future.

Association of Age-Related Macular Degeneration With Risk of All-Cause and Specific-Cause Mortality in the National Health and Nutrition Examination Survey, 2005 to 2008

“…In the analysis of cause-specific mortality, our results support those of a recent meta-analysis of 5 population-based studies 26 that suggest that AMD is not associated with CVD mortality. However, our findings were challenged by 2 recent meta-analyses 42 , 43 that concluded that AMD, specifically late AMD, was associated with an increased risk of CVD mortality.…”

“…This explanation is supported by results from the present study and previous studies. 7 , 14 , 26 , 56 Common pathogenesis, such as chronic inflammation, atherosclerosis, oxidative stress, and lipid metabolism might be the main mechanism between AMD and systemic comorbidities. 56 , 57 , 58 The implications of these findings suggest that AMD is a biomarker of frailty and aging.…”

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 Speculation has suggested that these inconsistent results arise from inadequate adjustment of important confounding factors, for example AMD-associated systemic comorbidities (CVD) that may lead to poorer survival. 26 Moreover, most previous studies 27 might overestimate the absolute risk of CVD mortality by failing to account for a competing risk of death. Given the current concern that injection of anti–vascular endothelial growth factor (anti-VEGF) may lead to increased risks of thromboembolic events, 28 , 29 knowledge of the accurate influence of AMD on mortality risk, especially CVD mortality, is warranted.…”

Legume Consumption and All-Cause and Cardiovascular Disease Mortality

“…The differences in view regarding the selection were resolved by discussion. If one study had multiple publications, we selected the largest sample of articles [ 15 ].…”

“…Review Manager software (version 5.3; the Nordic Cochrane Centre, Copenhagen, Denmark) was used for the statistical analyses, which is provided by Cochrane collaboration. A two-sided P value of less than 0.05 was considered statistically significant [ 15 ].…”