Age-related macular degeneration and risk for stroke
Age-related macular degeneration and risk for stroke
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DOI：
10.7326/0003-4819-145-2-200607180-00007
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发表时间：
2006-07-18
影响因子：
39.2
通讯作者：
Sharrett, A. Richey
中科院分区：
文献类型：
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作者：
Wong, Tien Yin;Klein, Ronald;Sharrett, A. Richey
背景：在美国，视网膜相关性黄斑变性（AMD）影响着700万40岁及以上的人。该疾病的危险因素与中风的危险因素相似。目的：确定AMD和临床中风事件之间是否存在任何关系。设计：前瞻性队列研究。设置：基于人群的动脉粥样硬化风险社区研究，在明尼苏达州、马里兰州、密西西比和北卡罗来纳州进行。患者：10405名年龄在49岁至73岁之间、没有中风或冠心病病史的人。测量：参与者在1993年至1995年间拍摄了视网膜照片。使用标准化方案来评估照片中玻璃疣和AMD的其他体征的存在。事件中风事件进行了识别和验证，通过审查case records.Results：有498早期和10晚期AMD的情况下，在队列（n = 508）。在10年的时间里，241人发生了中风事件。在调整了年龄、性别、种族和部位后，作者发现早期AMD患者的卒中累积发生率高于无疾病患者（4.08% vs. 2.14%）。早期AMD的存在与较高的卒中校正风险相关（风险比，1.87 [95%CI，1.21 - 2.88]）。进一步调整收缩压、糖尿病、吸烟和使用抗高血压药物并没有实质性改变这种关联（风险比，1.85 [CI，1.19 - 2.87]）。作者发现，早期AMD和中风之间的关联因研究地点和患者种族而异。明尼苏达州和马里兰州白色患者样本的多变量校正风险比分别为3.15和1.07;密西西比州非洲裔美国人样本为3.77;北卡罗来纳州大部分白色患者（91%）样本为0.33。没有网站包括足够数量的非洲裔美国人和白色患者，以确定种族是否有助于观察到的差异由study site.Limitations：有少数情况下，晚期AMD，和队列组装方法禁止充分了解种族和site.Conclusion：中年人早期AMD的迹象有较高的中风风险独立于传统的中风危险因素。
Background: Age-related macular degeneration (AMD) affects 7 million persons 40 years of age and older in the United States. Risk factors for the disease are similar to those for stroke.Objective: To determine what relationship, if any, exists between AMD and incident clinical stroke.Design: Prospective cohort study.Setting: The population-based Atherosclerosis Risk in Communities Study, which was conducted in Minnesota, Maryland, Mississippi, and North Carolina.Patients: 10405 persons between 49 and 73 years of age who had no history of stroke or coronary heart disease.Measurements: Participants had retinal photographs taken between 1993 and 1995. A standardized protocol was used to evaluate the photographs for the presence of drusen and other signs of AMD. Incident stroke events were identified and validated by reviewing case records.Results: There were 498 early-stage and 10 late-stage cases of AMD in the cohort (n = 508). Over a 10-year period, 241 persons had an incident stroke event. After adjusting for age, sex, ethnicity, and site, the authors found that persons with early-stage AMD had a higher cumulative incidence of stroke than those without disease (4.08% vs. 2.14%). The presence of early-stage AMD was associated with a higher adjusted risk for stroke (hazard ratio, 1.87 [95% CI, 1.21 to 2.88]). Further adjustment for systolic blood pressure, diabetes, cigarette smoking, and use of anti hypertensive medications did not substantially alter this association (hazard ratio, 1.85 [CI, 1.19 to 2.87]). The authors found that the association between early-stage AMD and stroke varied by study site and patient ethnicity. Multivariable-adjusted hazard ratios were 3.15 and 1.07 in samples of white patients in Minnesota and Maryland, respectively; 3.77 in a sample of African-American patients in Mississippi; and 0.33 in a sample of mostly white patients (91 %) in North Carolina. No site included sufficient numbers of both African-American and white patients to determine whether ethnicity contributed to the observed differences by study site.Limitations: There were few cases of late-stage AMD, and the cohort assembly method prohibited full understanding of variation by ethnicity and site.Conclusion: Middle-aged persons with signs of early-stage AMD have a higher risk for stroke independent of traditional stroke risk factors.