Associations of cardiovascular risk factors with age-related macular degeneration in Asians: Pooled analysis from 5 population-based studies

Abstract

Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness among the elderly. A common pathogenetic mechanism, covering AMD and cardiovascular disease has been postulated, but the associations between these conditions have not been consistent. The purpose of the study was to investigate the association of cardiovascular risk factors with AMD in multi-ethnic populations in Asia.

Methods: This pooled analysis included participants recruited from 5 population-based studies: these include gradable photographs from the Singapore Malay Eye Study, Singapore Indian Eye Study, Singapore Chinese Eye Study, Singapore Cardiovascular Cohort Study, and Singapore Prospective Study Program. Participants underwent a detailed questionnaire and a comprehensive physical examination, including fundus photography. AMD status was graded based on the fundus photos according to the Wisconsin age-related maculopathy grading system. A total of 13,894 subjects with gradable photographs were included in the analysis.

Results: In the study populations, 813 (5.9%) subjects had early AMD and 881 (6.4%) had any AMD. In multiple regression models adjusted for age, gender, study, ethnicity and smoking status, presence of hypertension (odds ratio [OR] = 1.24, 95% confidence interval [CI]: 1.04,1.47), lower total cholesterol (OR = 0.77 [highest quartile compared to lowest quartile], 95% CI: 0.62, 0.95), higher HDL cholesterol (OR = 1.34 [highest quartile compared to lowest quartile], 95% CI: 1.06, 1.69), and higher body mass index (OR = 1.28 [body mass index ≥ 30 compared to 18.5 ≤ body mass index < 25], 95% CI: 1.01, 1.62) were significantly associated with any AMD. Similar risk factors were found for early AMD.

Conclusions: Hypertension, higher HDL cholesterol and higher body mass index, which showed inconsistent associations with any AMD in European-ancestry populations, are factors associated with any AMD in Asian populations.

Keywords: 412 age-related macular degeneration • 413 aging • 688 retina