Association of Age-Related Macular Degeneration with Cholelithiasis

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-03-19 DOI:10.1016/j.xops.2025.100771

Kevin R. Zhang MD, PhD , Rohini M. Nair PhD , Yineng Chen MS , Fangming Jin MS , Joshua Dunaief MD, PhD , Brian L. VanderBeek MD, MPH

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Abstract

Purpose

Dysregulated lipid metabolism likely contributes to the pathogenesis of age-related macular degeneration (AMD). There is an overlap in risk factors between AMD and diseases of lipid metabolism, such as cholelithiasis, suggesting that an association between these diseases could provide insight into AMD pathogenesis. This study sought to determine if there is an association between cholelithiasis and AMD.

Design

A cohort study was conducted using patients in the Optum deidentified Clinformatics Data Mart database from January 1, 2000, to June 30, 2022.

Participants

Patients over the age of 55 with ≥2 years of data and no prior history of AMD were included. The exposed cohort included patients who had a history of cholelithiasis, cholecystitis, or cholecystectomy. The control cohort included patients with gastroesophageal reflux disease (GERD), matched for age ±3 years, sex, race, and year of index date.

Methods

Propensity scores were created using multivariable logistic regression and applied to inverse probability of treatment weighting (IPTW). Cox proportional hazard regression modeling with IPTW was used to compare progression to AMD in each cohort.

Main Outcome Measures

Progression to AMD for patients with cholelithiasis, cholecystitis, or a history of cholecystectomy.

Results

A total of 332 536 patients with cholelithiasis and 776 591 matched GERD controls were analyzed. After IPTW, the mean age (±standard deviation) was 66.6 ± 9.4 years in the cholelithiasis cohort and 67.5 (±10.3) years in the GERD cohort. Women comprised 58% of the cholelithiasis cohort and 57% of the GERD cohort. In the cholelithiasis cohort, 3511.7 (1.14%) were diagnosed with AMD, compared with 23 367.1 (2.92%) in the GERD cohort and corresponding to a significantly decreased hazard of AMD (adjusted hazard ratio [aHR] = 0.72, 95% confidence interval [CI]: 0.69–0.75, P < 0.0001). In the subanalysis, before IPTW weighting, AMD developed in 3809 of 275 897 (1.4%) patients with only cholelithiasis (aHR = 0.76, 95% CI: 0.73–0.80, P < 0.0001), 335 of 47 166 (0.71%) patients with cholecystitis (aHR = 0.54, 95% CI: 0.47–0.61, P < 0.0001), and 114 of 9473 (1.20%) patients who underwent cholecystectomy (aHR = 0.50, 95% CI: 0.41–0.63, P < 0.0001).

Conclusions

Cholelithiasis was associated with a 28% hazard reduction in AMD. More severe gallbladder disease conferred greater protection.

Financial Disclosure(s)

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

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老年性黄斑变性与胆石症的关系

目的脂质代谢失调可能与年龄相关性黄斑变性（AMD）的发病机制有关。黄斑变性与脂质代谢疾病（如胆石症）之间的危险因素有重叠，提示这些疾病之间的关联可能为黄斑变性的发病机制提供线索。本研究旨在确定胆石症和AMD之间是否存在关联。DesignA队列研究于2000年1月1日至2022年6月30日在Optum确定的临床数据集市数据库中对患者进行了研究。参与者：年龄在55岁以上，既往无AMD病史，既往资料≥2年的患者被纳入研究。暴露队列包括有胆石症、胆囊炎或胆囊切除术史的患者。对照队列包括胃食管反流病（GERD）患者，年龄±3岁，性别，种族和索引日期年份相匹配。方法采用多变量logistic回归建立倾向得分，并应用于处理加权逆概率（IPTW）。采用IPTW的Cox比例风险回归模型比较每个队列中AMD的进展情况。主要观察指标：有胆结石、胆囊炎或胆囊切除术史的患者进展为AMD。结果共分析了332 536例胆石症患者和776 591例匹配的GERD对照组。IPTW后，胆结石组的平均年龄（±标准差）为66.6±9.4岁，GERD组的平均年龄为67.5（±10.3）岁。女性占胆结石组的58%，占胃食管反流组的57%。在胆结石组中，有3511.7例（1.14%）被诊断为AMD，而在GERD组中有23367.1例（2.92%）被诊断为AMD，相应的AMD的风险显著降低(校正风险比[aHR] = 0.72, 95%可信区间[CI]: 0.69-0.75, P <；0.0001)。在亚组分析中，IPTW加权前，275897例（1.4%）患者中有3809例(aHR = 0.76, 95% CI: 0.73-0.80, P <；0.0001)， 47 166例胆囊炎患者中有335例（0.71%）(aHR = 0.54, 95% CI: 0.47-0.61, P <；0.0001)， 9473例患者中有114例（1.20%）行胆囊切除术(aHR = 0.50, 95% CI: 0.41-0.63, P <；0.0001)。结论胆石症与AMD风险降低28%相关。胆囊疾病越严重，保护作用越强。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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