Age-related macular degeneration and risk of stroke and all-cause mortality

Abstract

Introduction: Age-related macular degeneration (AMD) is the most common degenerative disorder of the retina and choroid. Retinal vascular diseases have been associated with adverse cardiovascular outcomes, but an association between AMD and stroke has not been well established. We aimed to test the relationship between AMD, stroke, and age-adjusted mortality.

Material and methods: Data was obtained from the US National Health and Nutrition Examination Surveys 2005 to 2008, with linked mortality through to 2015. Participants aged 40 or older with gradable AMD on fundus photographs were included. AMD was classified as either early or late. Independent relationships between AMD and stroke were assessed using multivariable logistic regression models. Risk of all-cause mortality was assessed using Cox regression models, before and after adjusting for covariates.

Results: Of the 5,481 participants included, 49.8% were women, 56.5% white, 20.3% black, and 15.5% Hispanic. 425 (7.8%) had AMD. After adjusting for vascular risk factors, we found that AMD was associated with an increased risk of stroke (aOR 1.87, 95% CI 1.25-2.79, p = 0.002). There was a relationship between AMD and stroke depending on whether participants had early AMD (aOR 1.66, 95% CI 1.09-2.51) or late AMD (aOR 3.32, 95% CI 1.36-8.12). All-cause mortality was higher in those with AMD (HR 1.35, 95% CI 1.06-1.72) and late AMD (HR 2.18, 95% CI 1.33-3.58).

Conclusions: Age-related macular degeneration is associated with stroke and all-cause mortality, independent of age and vascular risk factors. Our findings suggest potential non-vascular mechanisms related to the aetiology of AMD may increase the risk of stroke.

Keywords: NHANES; all-cause mortality; macular degeneration; stroke.