Early age-related maculopathy in the cardiovascular health study

doi:10.1016/S0161-6420(02)01565-8

Ophthalmology

Volume 110, Issue 1, January 2003, Pages 25-33

https://doi.org/10.1016/S0161-6420(02)01565-8 Get rights and content

Abstract

Objective

To describe the prevalence of early age-related maculopathy (ARM) and its relation to atherosclerosis, lipids, hypertension, and inflammatory factors in a population studied for cardiovascular disease risk factors and outcomes.

Design

Population-based cohort study.

Participants

A biracial population of 2361 adults (ranging from 69–97 years of age; 1998 whites and 363 blacks) living in four US counties (Allegheny County, Pennsylvania; Forsyth County, North Carolina; Sacramento County, California; and Washington County, Maryland) were examined during the interval from 1997 to 1998.

Methods

Drusen and other lesions typical of ARM were identified by examining a 45° color fundus photograph of one eye of each participant and classified by means of a modification of the Wisconsin Age-Related Maculopathy Grading System.

Main outcome measures

Early ARM.

Results

Early ARM was present in 15.5% and late ARM in 1.3% of the cohort. The overall prevalence of any ARM was lower in blacks (9.1%) compared with whites (18.2%). While controlling for age, race, gender, and total calories consumed in the diet, factors associated with ARM were cerebral white matter disease as detected by magnetic resonance imaging (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.05, 2.16, P = 0.027), and lower serum total cholesterol (OR, per 10 mg/dl increase 0.95; 95% CI, 0.91, 0.98, P = 0.02). There were no associations between hypertension, blood pressure, common carotid artery plaque, or any systemic inflammatory factors studied and early ARM.

Conclusions

This population-based study documents the higher prevalence of ARM in whites compared with blacks. Although an association was found between signs of white matter disease and early ARM, there was no evidence of an association of ARM with either hypertension or inflammatory factors.

Section snippets

Population

The Cardiovascular Health Study (CHS) is a prospective, population-based longitudinal study of coronary heart disease and stroke in adults 65 years of age and older.34 Participants in the CHS were recruited from four counties (Allegheny County, Pennsylvania; Forsyth County, North Carolina; Sacramento County, California; and Washington County, Maryland). Recruitment was from a random sample of Health Care Financing Administration Medicare eligibility lists from these four counties. Potential

Prevalence

The prevalence of lesions of ARM and early and late ARM by race, gender, and age are shown in Table 2. ARM was detected in 16.8% of the cohort (396 of 2361), with 15.5% (366 of 2361) having early ARM and 1.3% (30 of 2361) having late ARM (Table 2). The frequency of ARM increased with age. While controlling for age, there was no difference by gender in the odds of early or late ARM (odds ratio [OR] 1.01; 95% confidence interval [CI], 0.80,1.27; P = 0.97 and OR, 1.08; 95% CI, 0.52,2.25; P =

Discussion

The CHS, an investigation of subclinical and clinical atherosclerosis and other factors associated with aging, provided an opportunity to examine the prevalence of ARM and its lesions and the relationship of atherosclerosis, hypertension, and inflammatory factors to ARM in a large cohort of older adults living in the United States. The presence and severity of ARM was determined by grading fundus photographs in a masked fashion by means of a standard classification system.

One sign of

Acknowledgements

The authors thank the Fundus Photograph Reading Center grading staff, Kathleen Miner, Barbara Esser, Cynthia Hurtenbach, and Kurt Osterby.

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^☆

Manuscript no. 210630.

Supported by the National Heart, Lung and Blood Institute Bethesda, Maryland (Cardiovascular Health Study contract NHLBI HC-97-06) and, in part, by Research to Prevent Blindness, New York, New York (R. Klein, Senior Scientific Investigator Award).

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Regular articleEarly age-related maculopathy in the cardiovascular health study☆

Abstract

Objective

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Population

Prevalence

Discussion

Acknowledgements

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ann Epidemiol

Ann Epidemiol

Ophthalmology

Ophthalmology

Am J Cardiol

Prog Retin Eye Res

Ophthalmology

Ophthalmology

Ophthalmology

The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity

Invest Ophthalmol Vis Sci

Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration. Updated findings from two clinical trials

Arch Ophthalmol

Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin. one-year results of 2 randomized clinical trials-TAP Report 1. Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study Group

Arch Ophthalmol

Epidemiology

Pathogenesisa hemodynamic model

An hypothesis on macular disease

Trans Am Acad Ophthalmol Otolaryngol

Analysis of lipid deposits extracted from human macular and peripheral Bruch’s membrane

Arch Ophthalmol

Senile macular degeneration and risk factorsa case-control study

Ann Ophthalmol

Senile macular degenerationa preliminary study

Ann Ophthalmol

Senile macular degenerationa case-control study

Am J Epidemiol

Association between drusen and some of the risk factors for coronary artery disease

Ophthalmologica

Risk factors for neovascular age-related macular degeneration

Arch Ophthalmol

Regular article
Early age-related maculopathy in the cardiovascular health study☆