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S.C. Tomany, J.J. Wang, R. van Leeuwen, R. Klein, P. Mitchell, P.T. de Jong, B.E. Klein, W. Smith; Risk Factors for Incident Age-Related Macular Degeneration: Pooled Findings from Three Continents . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3079.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To examine the relationship between late age-related maculopathy (ARM) and potential risk factors using data from three populations-based cohort studies. Methods: Includes 9,523 persons participating in baseline and five- or six-year follow-up examinations, of whom, 3562, 2330, and 3631 participants were provided by the Beaver Dam Eye Study (BDES), Blue Mountains Eye Study (BMES), and Rotterdam Eye Study (RES), respectively. Participants were aged 43 to 95 years (43 to 86 years in BDES, 45 to 93 years in BMES, and 55 to 95 years in RES) at baseline examinations, which were completed from 1988 to 1990 in BDES, 1992 to 1994 in BMES, and 1990 to 1993 in RES. Five-year follow-up was conducted between 1993 and 1995 in BDES and 1997 and 1999 in BMES. In RES, six-year follow-up was conducted between 1996 and 1999. Data on risk factors at baseline were obtained from a physical examination and a standardized questionnaire. In each of these studies, ARM status was determined by grading stereoscopic color fundus photos using a similar standardized protocol. All cases of incident late ARM were crosschecked and confirmed by the principal investigators of the studies. Results: Of the 9,523 participants included in this analysis, 102 (1.1%) developed late ARM (neovascular ARMD or geographic atrophy). After controlling for age, gender, and data origin, participants who smoked at baseline were at increased risk of developing late ARM (OR: 2.00; 95% CI: 1.12,3.56; p-value=0.02) at follow-up when compared to participants who never smoked. The risk of developing exudative ARM was found to decrease by 7% (OR: 0.93; 95% CI: 0.87,0.99; p-value=0.02) for every 10mmol/L increase in serum total cholesterol. This relationship held after adjusting for smoking status at baseline. The incidence of late ARM was not found to be associated with baseline iris color, body mass index, serum HDL cholesterol, systolic or diastolic blood pressure, white blood cell count, hypertension status, history of myocardial infarction or, specific to women, menopausal status, age at menopause, time from menarche to menopause, or use of hormone replacement therapy. Conclusions: These data confirm smoking as a major modifiable risk associated with incident late ARM. Our analyses also found an inverse relationship between serum total cholesterol and incident exudative ARM.
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