Cardiovascular disease and hypertension are strong risk factors for choroidal neovascularization
Cardiovascular disease and hypertension are strong risk factors for choroidal neovascularization
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DOI：
10.1016/j.ophtha.2007.07.031
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发表时间：
2008-06-01
期刊：
影响因子：
13.7
通讯作者：
Chakravarthy, Usha
中科院分区：
文献类型：
--
作者：
Hogg, Ruth E.;Woodside, Jayne V.;Chakravarthy, Usha
目的：探讨心血管危险因素和炎性标志物与新生血管性老年性黄斑变性(AMD)的关系。设计：横断面病例对照研究。参与者：受邀参加的410名65岁的社区样本中，205人参与(有效率50%)。在215名受邀参加的门诊患者中，212人同意参加(回复率为98%)。在193名门诊患者和2名社区样本中，至少有一只眼睛被诊断为新生血管性AMD。方法：诊所和社区参与者进行了详细的眼科检查和眼底成像，评估可能的危险因素，并提供血样。分析指标包括血脂、细胞间黏附分子1(ICAM)、血管细胞黏附分子(VCAM)和C反应蛋白(CRP)水平。主要观察指标：新生血管性AMD。结果：至少一只眼有195名脉络膜新生血管患者，97名非新生血管性AMD患者，115名对照组(双眼无玻璃体或色素异常)。在混杂因素调整的Logistic回归分析中，心血管病史与新生血管性AMD密切相关(优势比[OR]，7.53；95%可信区间[CI]，2.78-20.41)。吸烟(OR，3.71；95%CI，1.25~11.06)、体重指数(OR，3.82；95%CI，1.22~12.01)、2期高血压(OR，3.21；95%CI，1.14~8.98)、血清胆固醇(OR，4.66；95%CI，1.35~16.13)与新生血管性AMD呈正相关。AMD状态与血清CRP、ICAM或VCAM无关。结论：我们的结果提示心血管疾病在一定比例的老年人脉络膜新生血管的形成中起病因学作用，强调控制血压和胆固醇、避免吸烟和维持正常体重的重要性。
Purpose: To investigate the association of cardiovascular risk factors and inflammatory markers with neovascular age-related macular degeneration (AMD).Design: Cross-sectional case-control study.Participants: Of the 410 of the >= 65-year-old community sample invited to attend, 205 participated (50% response rate). Of the 215 clinic attendees who were invited to participate, 212 agreed to take part (98% response rate). A diagnosis of neovascular AMD in at least one eye was made in 193 clinic attendees and 2 of the community sample.Methods: Clinic and community participants underwent a detailed ophthalmic examination with fundus imaging, were interviewed for assessment of putative risk factors, and provided a blood sample. Analysis included levels of serum lipids, intercellular adhesion molecule 1 (ICAM), vascular cellular adhesion molecule (VCAM), and C-reactive protein (CRP). All participants were classified by fundus image grading on the basis of the eye with more severe AMD features.Main Outcome Measure: Neovascular AMD.Results: There were 195 participants with choroidal neovascularization in at least one eye, 97 nonneovascular AMD participants, and 115 controls (no drusen or pigmentary irregularities in either eye). In confounder-adjusted logistic regression, a history of cardiovascular disease was strongly associated with neovascular AMD (odds ratio [OR], 7.53; 95% confidence interval [CI], 2.78-20.41). Cigarette smoking (OR, 3.71; 95% CI, 1.25-11.06), being in the highest quartile of body mass index (OR, 3.82; 95% CI, 1.22-12.01), stage 2 hypertension (OR, 3.21; 95% CI, 1.14-8.98), and being in the highest quartile of serum cholesterol (OR, 4.66; 95% CI, 1.35-16.13) were positively associated with neovascular AMD. There was, no association between AMD status and serum CRP, ICAM, or VCAM.Conclusions: Our results suggest that cardiovascular disease plays an etiological role in the development of choroidal neovascularization in a proportion of older adults and highlight the importance of control of blood pressure and cholesterol, avoidance of smoking, and maintenance of a normal body weight.