Monitor Younger AMD Patients for Stroke, CVD

Tan JSL, Wang JJ, Liew G, et al. Age-related macular degeneration and mortality from cardiovascular disease or stroke. Br J Ophthalmol. 2008 Feb 29; [Epub ahead of print].

Results from an Australian study support the hypothesis of a link between age-related macular degeneration (AMD) and death from cardiovascular disease (CVD) or stroke. If replicated, Tan et al say, their findings could have important implications for the use of anti–vascular endothelial growth factor in the treatment of AMD, "which some reports suggest may increase cardiovascular risk."

The analysis focused on 2,853 persons 49 or older at baseline who participated in a population-based cohort study in Australia. Patients underwent stereoscopic retinal photography of both eyes at baseline, five-year follow-up, and 10-year follow-up. Deaths were confirmed through a national database, and causes of death were extracted from death certificates.

Fifty-one cases of late-stage AMD and 130 of early-stage AMD were identified at baseline. During 11 years of follow-up, 183 persons died of CVD, 99 of stroke, and 17 of the two causes combined. When the entire study population was considered, no significant association between either form of AMD and CVD- or stroke-related death was observed. However, among younger patients (age < 75), early AMD was associated with a relative risk (RR) for CVD-related death of 2.32 (following adjustment for multiple variables, including cardiac risk factors). In the same age-group, late AMD was associated with an RR of 5.57 for CVD-related death and of 10.21 for stroke-related death; these risk estimates could only be adjusted for age and gender, given the small number of cases involved.

While their findings "should be interpreted cautiously," Tan et al say, "The potential association between AMD and vascular disease, and mechanisms underlying this relationship, deserve further study."