Patients with Age-related Macular Degeneration Have Increased Susceptibility to Valvular Heart Disease

Abstract

Purpose

Valvular heart disease (VHD) contributes significantly to cardiovascular-related morbidity worldwide. Aortic valve stenosis is the third most common cardiovascular disease in the Western world, after hypertension and coronary artery disease. Recent studies have reported an association between VHD and the presence of subretinal drusenoid deposits (SDDs), a distinct manifestation of age-related macular degeneration (AMD). However, these findings were based on self-reported questionnaires and relatively modest cohort sizes. Our goal was therefore to investigate the putative associations between AMD and VHD and between the presence of SDDs and VHD.

Design

Retrospective case-control study.

Subjects

A total of 945 with AMD and 8275 control patients without AMD from a single tertiary center.

Methods

All patients with AMD underwent spectral-domain OCT (SD-OCT). The SD-OCT scans were annotated by 2 experienced graders. Among the patients with AMD, 547 had drusen and SDDs, and 398 had drusen only with no SDDs. We also extracted data from all 9220 patients’ electronic medical records, including demographics and previous heart valve procedures based on International Classification of Diseases, ninth revision codes.

Main Outcome Measures

Heart valve-related diagnoses and procedures performed in both patient groups.

Results

Patients with AMD had a higher prevalence of various VHDs compared with the control group, including increased rates of aortic stenosis (odds ratio [OR], 2.00; 95% confidence interval (CI), 1.40–2.86; P < 0.001), aortic regurgitation (OR, 2.41; 95% CI, 1.49–3.91; P < 0.001), and mitral valve regurgitation (OR, 1.51; 95% CI, 1.13–2.01; P = 0.004). Heart valve procedures were also more prevalent among AMD patients including aortic valve replacement (OR, 1.70; 95% CI, 1.08–2.66; P = 0.019) and tricuspid valve replacement (OR, 3.99; 95% CI, 1.03–15.46; P = 0.03). Moreover, a supervised machine learning model successfully detected the presence of AMD based solemnly on the patient’s history of VHD. In the AMD cohort, we found no significant difference in VHD prevalence between patients with nonneovascular AMD and patients with neovascular AMD, or between patients with SDDs and patients without SDDs.

Conclusions

Patients with AMD have a higher prevalence of VHD and are more likely to undergo a heart valve-related procedure compared with patients without AMD, with no difference between patients with SDDs and patients without SDDs in the AMD cohort.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.