Association between Age-related Macular Degeneration and mortality in a high cardiovascular risk cohort: A prospective cohort study.

Abstract

Objective: -To investigate if age-related macular degeneration (AMD) predicts risk of all-cause and cardiovascular disease (CVD) mortality in a high CVD risk cohort.

Design: - Prospective cohort study PARTICIPANTS: - 1545 adult participants who presented to a tertiary Australian hospital for evaluation of acute coronary syndrome were included in this study.

Methods: - Participants were evaluated for acute coronary syndrome using coronary angiography. Participants were concurrently examined for AMD from mydriatic fundus photographs which were graded using the Wisconsin grading system into categories of any AMD, early AMD and late AMD. Coronary artery disease (CAD) was graded from coronary angiograms using the Gensini score. Mortality data were obtained 9 years after baseline examination through data linkage with the Australian National Death Index. Hazard ratios (HR) were obtained using Cox regression analysis.

Main outcome measures: All-cause and CVD mortality data were obtained through data linkage with the Australian National Death Index. Death rates through June 2018 were compared by demographics and potential confounders.

Results: - Any AMD was identified in 107 (6.9%) participants, including those with early (n=86) and late AMD (n=21). Over 9 years of follow-up, 234 (15.1%) participants had died, including 174 (11.3%) participants from fatal CVD events. After controlling for age, sex, body mass index , total cholesterol, smoking status, history of diabetes, hypertension, myocardial infarction, stroke and macrovascular CAD severity using the Gensini score, there was an increased rate of all-cause mortality for those with any AMD (hazard ratio [HR] 2.37, [95% CI: 1.54-3.64]), early AMD (HR 2.42 [1.48-3.94]) and late AMD (HR 2.25 [1.08-4.71]). Any AMD (HR 2.62, [1.61-4.26]) and early AMD (HR 2.61 [1.50-4.64]) were also associated with a greater likelihood of CVD mortality. Late AMD was not associated with CVD mortality.

Conclusions: - In individuals with high CVD risk, presence of AMD at any stage independently predicted increased all-cause mortality. Meanwhile, any and early AMD increased risk of CVD mortality. Although mechanisms are unclear, this potentially reflects shared pathways between AMD and CVD.