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Mohammad K. Ikram, Paul Mitchell, Ronald Klein, Barbara E. Klein, Richey Sharrett, David J. Couper, Tien Y. Wong; Age-related Macular Degeneration And Long-term Risk Of Stroke Subtypes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3820.
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We examined the relationship of age-related macular degeneration (AMD) to incident stroke and its subtypes cerebral infarction and intracerebral haemorrhage (ICH).
The Atherosclerosis Risk in Communities Study (ARIC) is a population-based cohort study in middle-aged persons sampled from four U.S. communities. For the present study 12,216 participants aged 49 to 73 were included, who had 45° retinal photographs taken of one eye at the third examination visit between 1993 and 1995. AMD signs were assessed by masked grading using a standardized protocol. Incident events of stroke and its subtypes cerebral infarction and ICH were identified and validated via case record review over time.
A total of 591 participants were diagnosed with AMD, of whom 576 had early and 15 late AMD. After a mean follow-up period of 13.0 years (standard deviation: 3.3), 619 persons developed an incident stroke, including 548 cerebral infarction and 57 ICH. After controlling for age, gender, race, field center, blood pressure, fasting glucose, total cholesterol, cigarette smoking, and other cardiovascular factors, participants with any AMD were at an increased risk of developing an incident stroke (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: 1.11-2.06), with a stronger association for ICH (HR: 2.64; 95% CI: 1.18-5.87) than cerebral infarction (HR: 1.42; 95% CI: 1.01-1.99).
Persons with AMD are at an increased risk of both cerebral infarction and ICH, independent of traditional cardiovascular risk factors. These data provide further insights into common pathophysiological processes between AMD and stroke subtypes, and have implications in the management of patients with AMD.
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