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M.-N. Delyfer, P. Barberger-Gateau, M.-B. Rougier, J. Colin, F. Malet, M. Le Goff, J.-F. Dartigues, J.-F. Korobelnik, C. Delcourt; Complement Factor H, Smoking and the Risk for Age-Related Maculopathy: The Alienor Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):272.
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Data from population-based epidemiological studies are necessary, in order to better estimate the associations of Complement Factor H (CFH) with age-related maculopathy (ARM). In particular, few data are available on non-neovascular ARM and on the respective roles of CFH and smoking.
The Alienor Study is a population-based study on nutrition and age-related eye diseases. 963 subjects were recruited from September 2006 to May 2008. CFH polymorphism was determined in 878 subjects (91.2 %), from DNA collected in 1999-2001. 796 of 878 (90.7 %) had gradable photographs and were classified in 5 exclusive stages (worse eye): neovascular ARM (stage 4, n= 22); geographic atrophy (stage 3, n=22); large soft indistinct drusen and/or reticular drusen and/or large distinct drusen with pigment abnormalities (stage 2, n=87); large soft distinct drusen alone or pigment abnormalities alone (stage 1, n=144); stage 0 (n=521). Associations were estimated using polytomous logistic regression, after adjustment for age and gender, stage 0 being the reference in all analyses.
CFH polymorphism was strongly associated with neovascular ARM (OR= 9.9, 95 % confidence interval (CI) 2.3 - 41.8, p= 0.002 for TC subjects and OR= 5.2, 95 % CI: 1.4 - 18.4, p= 0.01 for CC subjects, vs TT subjects) and stage 2 ARM (OR=2.2, 95 % : 1.1 - 4.4, p=0.01 and OR=1.6, 95 % CI: 1.0 - 2.7, p= 0.06, respectively). It was not significantly associated with geographic atrophy (OR= 0.8, 95 %CI : 0.2 - 3.8, p= 0.79 and OR= 0.6, 95 % CI : 0.2 - 1.6 , p=0.30, respectively) and stage 1 ARM (OR=1.5, 95 % CI : 0.8 - 2.6, p=0.20 and OR= 1.0, 95 % CI: 0.7 - 1.5, p=0.90). Subjects having smoked 20 pack-years or more had significantly increased risk of neovascular ARM (OR=3.4, 95 % CI: 1.1 - 10.8, p=0.04), but not of geographic atrophy (OR= 1.0, 95 % CI : 0.3 - 3.3, p=0.96). They were also at higher risk of stage 2 ARM (OR= 1.9, 95 % CI: 1.0 - 3.4, p=0.04) and tended to be at higher risk of stage 1 ARM (OR= 1.5, 95 % CI : 0.9 - 2.5, p=0.11). Associations of ARM stages with smoking were not affected by further adjustment on CFH polymorphism. No statistical interactions of CFH with smoking were detected.
This population-based study confirms the contribution of both CFH and smoking to the aetiology of ARM. CFH was associated with neovascular and early (stage 2) ARM, but not with geographic atrophy.
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