The association of cardiovascular disease with the long-term incidence of age-related maculopathy: The beaver dam eye study

doi:10.1016/S0161-6420(03)00599-2

Ophthalmology

Volume 110, Issue 6, June 2003, Pages 1273-1280

https://doi.org/10.1016/S0161-6420(03)00599-2 Get rights and content

Abstract

Purpose

To examine the association between cardiovascular disease and its risk factors and the 10-year incidence of age-related maculopathy.

Design

Population-based cohort study.

Participants

Persons 43 to 86 years of age at baseline examination from 1988 to 1990, living in Beaver Dam, Wisconsin, of whom 3684 persons participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up examination.

Methods

Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy. The Kaplan–Meier (product–limit) survival approach and discrete linear logistic regression were used in the data analysis.

Main outcome measures

Incidence and progression of age-related maculopathy.

Results

When age, gender, and history of heavy drinking, smoking, and vitamin use were controlled for, higher systolic blood pressure at baseline was associated with the 10-year incidence of retinal pigment epithelial depigmentation (risk ratio [RR] per 10 mmHg systolic blood pressure, 1.10; 95% confidence interval [CI], 1.01–1.18; P = 0.02) and exudative macular degeneration (RR, 1.22; 95% CI, 1.06–1.41; P = 0.006). Higher pulse pressure at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR per 10 mmHg, 1.17; 95% CI, 1.07–1.28; P < 0.001), increased retinal pigment (RR, 1.10; 95% CI, 1.01–1.19; P = 0.03), exudative macular degeneration (RR, 1.34; 95% CI, 1.14–1.60; P < 0.001), and progression of age-related maculopathy (RR, 1.08; 95% CI, 1.01–1.17; P = 0.03). Higher serum high-density lipoprotein cholesterol at baseline was associated with pure geographic atrophy (RR per 10 mg/dl high-density lipoprotein cholesterol, 1.29; 95% CI, 1.05–1.58; P = 0.01). Physical activity at baseline was associated with the incidence of geographic atrophy (RR in those who worked up a sweat 5 times a week compared with those who did not, 0.12; 95% CI, 0.02–0.91; P = 0.04) exudative macular degeneration (RR, 0.27; 95% CI, 0.08−0.87; P = 0.05), and progression of age-related maculopathy (RR, 0.69; 95% CI, 0.47–1.00; P = 0.05). Neither a history of stroke nor heart attack was associated with the incidence or progression of age-related maculopathy.

Conclusions

These findings indicate relationships between higher pulse pressure (a presumed indicator of age-related elastin and collagen changes in Bruch’s membrane) and systolic blood pressure with an increased 10-year incidence of some lesions defining early age-related maculopathy and exudative macular degeneration.

Section snippets

Population

Methods used to identify and describe this population have appeared in previous articles.19, 20, 21, 22, 23 In brief, a private census of the population of Beaver Dam, Wisconsin, was performed from September 15, 1987 to May 4, 1988 to identify all residents in the city or township of Beaver Dam who were 43 to 84 years of age. Of the 5924 eligible individuals, 4926 participated in the baseline examination between March 1, 1988 and September 14, 1990.19 Ninety-nine percent of the population was

Results

Mean systolic blood pressure (124.3 vs. 140.0 mmHg), pulse pressure (44.5 vs. 67.4 mmHg), serum total cholesterol (225.1 vs. 237.3 mg/dl), and glycosylated hemoglobin (5.7% vs. 6.0%) increased with age (43–54 years vs. ≥75 years), whereas diastolic blood pressure (79.7 vs. 72.6 mmHg) and pulse rate (38.4 vs. 37.7 beats/30 seconds) decreased with age. There was no relationship of either serum HDL cholesterol or hematocrit with age. The prevalence of hypertension (22.2% vs. 52.1%), myocardial

Discussion

Data from the 10-year incidence study in Beaver Dam showed that when other factors were controlled for, persons with previously diagnosed, treated, and controlled hypertension at baseline were approximately twice as likely, and persons with treated and uncontrolled hypertension were approximately thrice as likely, to develop exudative macular degeneration than persons who were normotensive. These findings are consistent with data from a number of studies.5, 36, 37, 38 In a large case-controlled

Acknowledgements

The authors thank the Beaver Dam Scientific Advisory Board (Drs. Mae Gordon, Lee Jampol, Mary Frances Cotch, Natalie Kurinij, Daniel Seigel, and Robert Wallace) and Drs. George Davis, Alan Ehrhardt, and Thomas Castillo for their contributions.

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^☆

Manuscript no. 220059.

Supported by the National Institutes of Health (grant no.: EY06594) (RK, BEKK), Bethesda, Maryland, and, in part, by the Research to Prevent Blindness (RK, Senior Scientific Investigator Award), New York, New York.

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The association of cardiovascular disease with the long-term incidence of age-related maculopathy: The beaver dam eye study☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Population

Results

Discussion

Acknowledgements

Ophthalmology

Ophthalmology

Prog Retin Eye Res

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Senile macular degenerationreview of epidemiologic features

Am J Epidemiol

Senile macular degenerationa case control study

Am J Epidemiol

Cataracts and macular degeneration in older Americans

Arch Ophthalmol

The Framingham Eye Study. II. Association of ophthalmic pathology with single variables previously measured in the Framingham Heart Study

Am J Epidemiol

Risk factors for neovascular age-related macular degeneration

Arch Ophthalmol

Age-related macular degeneration is associated with atherosclerosis. The Rotterdam Study

Am J Epidemiol

Plasma fibrinogen levels, other cardiovascular risk factors, and age-related maculopathythe Blue Mountains Eye Study

Arch Ophthalmol

Prevalence of age-related maculopathy in the Atherosclerosis Risk in Communities Study

Arch Ophthalmol

Associations of cardiovascular disease and its risk factors with age-related macular degenerationthe POLA study

Ophthalmic Epidemiol

Do age-related macular degeneration and cardiovascular disease share common antecedents?

Ophthalmic Epidemiol

Changes in the choriocapillaris associated with senile macular degeneration

Ann Ophthalmol