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Smith SE, Lynch AM, Auer EA, Bol KA, Christopher KL, Mandava N, Patnaik JL. Visual Functioning and Mortality of Age-Related Macular Degeneration Patients in a Colorado Cohort. Ophthalmol Retina 2023; 7:982-989. [PMID: 37437714 PMCID: PMC10776804 DOI: 10.1016/j.oret.2023.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To investigate the relationship between visual functioning as measured by the National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and mortality in patients with various stages of age-related macular degeneration (AMD). DESIGN Observational cohort study. PARTICIPANTS Patients with AMD enrolled in the University of Colorado AMD Registry between July 9, 2014 and December 31, 2021 were included. METHODS Age-related macular degeneration cases were classified into early AMD, intermediate AMD, geographic atrophy, neovascular AMD, or both advanced types of AMD (neovasuclar and geographic atrophy both present) using multimodal imaging and the Beckman and Classification of Atrophy Meetings criteria. Visual Function Questionnaire -25 composite and subscale scores at the time of study enrollment were calculated. Cox proportional hazards modeling was used to assess time to event for mortality utilizing univariate and multivariable models, which adjusted for all variables significantly associated with mortality. The measures of association were hazard ratios (HRs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURES All-cause mortality statistics were obtained through a collaborative agreement with the Colorado Department of Public Health and Environment. Death rates through October 19, 2022 were compared by demographics and potential confounders. RESULTS Analysis was completed on a cohort of 876 patients, of which 180 (20.6%) died during the follow-up period. Average follow-up time for this cohort was 52.5 (standard deviation: 26.6) months. In univariate analysis, composite VFQ-25 score and all subscale scores aside from ocular pain were significantly associated with time to mortality. Additionally, age, AMD category, marital status, history of smoking, and multiple chronic comorbid conditions were significantly associated with time to mortality. In multivariable analysis, for each 10-point increase in a patient's VFQ-25 scores for general health and driving, the risk of death decreased with HR of 0.85 (95% CI: 0.80, 0.91; P < 0.0001) and 0.92 (95% CI: 0.87, 0.97; P = 0.005), respectively. Composite and other subscale scores were not significantly associated with mortality after adjusting for confounding variables. CONCLUSIONS This cohort of AMD patients had a 20% rate of death in the 52.5-month average follow-up time. Better general health and ability to drive, as measured by the VFQ-25, were each separately associated with significantly lower risk of death among individuals with AMD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sophie E Smith
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Emily A Auer
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Kirk A Bol
- Vital Statistics Program, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado.
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Vascular Aging and Damage in Patients with Iron Metabolism Disorders. Diagnostics (Basel) 2022; 12:diagnostics12112817. [PMID: 36428877 PMCID: PMC9689457 DOI: 10.3390/diagnostics12112817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Vascular aging is a physiological, multifactorial process that involves every type of vessel, from large arteries to microcirculation. This manifests itself as impaired vasomotor function, altered secretory phenotype, deteriorated intercellular transport function, structural remodeling, and aggravated barrier function between the blood and the vascular smooth muscle layer. Iron disorders, particularly iron overload, may lead to oxidative stress and, among other effects, vascular aging. The elevated transferrin saturation and serum iron levels observed in iron overload lead to the formation of a non-transferrin-bound iron (NTBI) fraction with high pro-oxidant activity. NTBI can induce the production of reactive oxygen species (ROS), which induce lipid peroxidation and mediate iron-related damage as the elements of oxidative stress in many tissues, including heart and vessels' mitochondria. However, the available data make it difficult to precisely determine the impact of iron metabolism disorders on vascular aging; therefore, the relationship requires further investigation. Our study aims to present the current state of knowledge on vascular aging in patients with deteriorated iron metabolism.
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Incidence and Prevalence of Neovascular Age-Related Macular Degeneration in France between 2008 and 2018. OPHTHALMOLOGY SCIENCE 2022; 2:100114. [PMID: 36246186 PMCID: PMC9562296 DOI: 10.1016/j.xops.2022.100114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Purpose This study aimed to estimate the incidence and prevalence of neovascular age-related macular degeneration (nAMD) in the French population between 2008 and 2018. Design This was a retrospective, longitudinal population study using health care consumption data from the Système National des Données de Santé (SNDS; the French National Health Information Database), which covers approximately 99% of the French population. Participants We identified individuals treated for nAMD from the French population 50 years of age and older. Identification criteria were nAMD diagnosis or reimbursement of nAMD treatments (anti–vascular endothelial growth factor intravitreal injection or dynamic phototherapy with verteporfin). Exclusion criteria were high myopia, diagnosis of other retinal diseases, and other treatments for macular diseases (dexamethasone implant, laser therapy, etc.). Methods We calculated incidence and prevalence based on the age-matched general population in France. Adjustment for age and sex was also performed for incidence. Main Outcome Measures Incidence and prevalence of nAMD in the French population between 2008 and 2018. Results Between 2008 and 2018, we identified 342 961 patients with nAMD (67.5% women). Mean ± standard deviation age at nAMD diagnosis or first treatment increased from 78.8 ± 8.1 years in 2008 to 81.2 ± 7.9 years in 2018. In 2018, annual incidence was 0.149% and prevalence was 1.062% for the French population 50 years of age or older. Incidence was stable over the 10-year period. Annual incidence increased with age (0.223%, 0.380%, and 0.603% in those 60 years of age or older, 70 years of age or older, and 80 years of age or older, respectively), with similar trends for prevalence. No major differences were observed among the 14 regions of France for incidence or prevalence. Neovascular age-related macular degeneration incidence in 2018 was not impacted by the availability of primary or ophthalmology care in patients’ localities. Conclusions The LANDSCAPE study provides exhaustive nationwide data on incidence and prevalence of nAMD in France over a 10-year period.
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Kanclerz P, Hanhart J, Tuuminen R. Association Between Mortality and Anti-Vascular Endothelial Growth Factor Treatment in Patients With Age-Related Macular Degeneration. JAMA Ophthalmol 2021; 139:1246-1247. [PMID: 34647975 DOI: 10.1001/jamaophthalmol.2021.4079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Piotr Kanclerz
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Hygeia Clinic, Gdańsk, Poland
| | - Joel Hanhart
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Chang CC, Huang CH, Chou YC, Chang JY, Sun CA. Association Between Age-Related Macular Degeneration and Risk of Heart Failure: A Population-Based Nested Case-Control Study. J Am Heart Assoc 2021; 10:e020071. [PMID: 34325520 PMCID: PMC8475704 DOI: 10.1161/jaha.120.020071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Heart failure (HF) is a major health problem worldwide because of its high morbidity and mortality. Recently, the role of the microvasculature in HF has gained more attention. Age‐related macular degeneration (AMD) is manifested through geographic atrophy or the development of neovascularization. However, there are limited data on investigations about the association between AMD and HF. The purpose of this study was to examine the association of AMD with the risk of HF in a large population‐based cohort of men and women. Methods and Results A nested case‐control study using Taiwan’s National Health Insurance Research Database was conducted between 2000 and 2012. Newly diagnosed heart failure cases (n=13 721) and matched controls (n=54 884) in the database were recruited. Patients who had ≥2 clinical visits with a diagnosis of AMD at least 1 year before the diagnosis of HF were identified as patients with AMD. Conditional logistic regressions were performed to calculate odds ratios and 95% CIs to assess the association between AMD and risk of HF. AMD was associated with a 1.58‐fold increased risk of HF (95% CI, 1.16–1.87) (P<0.001) after adjustment for potential confounders. This significant association was evident in both nonexudative and exudative AMD subgroups. Conclusions Our study provides evidence that AMD was associated with an increased risk of HF. Further molecular and pathophysiological studies are needed to clarify the underlying pathophysiological mechanisms behind the association of AMD with HF.
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Affiliation(s)
- Chao-Chien Chang
- Division of Cardiology Department of Internal Medicine Cathay General Hospital Taipei City Taiwan.,Graduate Institute of Medical Sciences College of MedicineTaipei Medical University Taipei City Taiwan.,Department of Pharmacology School of MedicineCollege of MedicineTaipei Medical University Taipei City Taiwan.,School of MedicineCollege of MedicineFu-Jen Catholic University New Taipei City Taiwan
| | - Chi-Hung Huang
- Division of Cardiology Department of Internal Medicine Cathay General Hospital Taipei City Taiwan.,School of DentistryCollege of Oral MedicineTaipei Medical University Taipei City Taiwan
| | - Yu-Ching Chou
- School of Public HealthNational Defense Medical Center Taipei City Taiwan
| | - Jin-Yin Chang
- Department of Medical Research Cathay General Hospital Taipei City Taiwan
| | - Chien-An Sun
- Department of Public Health College of MedicineFu-Jen Catholic University New Taipei City Taiwan.,Big Data Research Center College of MedicineFu-Jen Catholic University New Taipei City Taiwan
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Geographic atrophy severity and mortality in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 259:2643-2651. [PMID: 33742280 DOI: 10.1007/s00417-021-05145-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To examine the association between geographic atrophy (GA) disease characteristics and mortality risk. METHODS We manually delineated color fundus photographs of 209 Age-Related Eye Disease Study (AREDS) participants with GA secondary to age-related macular degeneration to identify total area of atrophy, GA effective radius growth rate, disease laterality, and the presence of foveal center involvement. Associations between GA characteristics and mortality were assessed with Cox proportional hazards models adjusted for health status indicators. RESULTS During a median follow-up of 6.8 years, 48 (23.0%) participants with GA died. In adjusted models, accounting for age, sex, and health status, participants with total GA area in the highest quartile had a significantly increased risk of all-cause mortality compared to those with total GA area in the lowest quartile (hazard ratio [HR], 3.42; 95% confidence interval [CI], 1.32-8.86; P = 0.011). GA effective radius growth rate, bilateral disease, and the presence of foveal center involvement were not significantly associated with mortality. In a multivariable model, including health status indicators and all GA characteristics, total area of atrophy in the highest quartile remained significantly associated with mortality (HR, 4.65; 95% CI, 1.29-16.70; P = 0.019). CONCLUSIONS More extensive GA, as indicated by a greater total area of atrophy, was associated with an increased risk of all-cause mortality in our cohort. The extent of GA may reflect the extent of underlying disease processes that contribute to greater mortality risk, further suggesting that GA may be part of a systemic rather than purely ocular disease process.
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Daniolou S, Rapp A, Haase C, Ruppert A, Wittwer M, Scoccia Pappagallo A, Pandis N, Kressig RW, Ienca M. Digital Predictors of Morbidity, Hospitalization, and Mortality Among Older Adults: A Systematic Review and Meta-Analysis. Front Digit Health 2021; 2:602093. [PMID: 34713066 PMCID: PMC8521803 DOI: 10.3389/fdgth.2020.602093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/17/2020] [Indexed: 12/17/2022] Open
Abstract
The widespread adoption of digital health technologies such as smartphone-based mobile applications, wearable activity trackers and Internet of Things systems has rapidly enabled new opportunities for predictive health monitoring. Leveraging digital health tools to track parameters relevant to human health is particularly important for the older segments of the population as old age is associated with multimorbidity and higher care needs. In order to assess the potential of these digital health technologies to improve health outcomes, it is paramount to investigate which digitally measurable parameters can effectively improve health outcomes among the elderly population. Currently, there is a lack of systematic evidence on this topic due to the inherent heterogeneity of the digital health domain and the lack of clinical validation of both novel prototypes and marketed devices. For this reason, the aim of the current study is to synthesize and systematically analyse which digitally measurable data may be effectively collected through digital health devices to improve health outcomes for older people. Using a modified PICO process and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, we provide the results of a systematic review and subsequent meta-analysis of digitally measurable predictors of morbidity, hospitalization, and mortality among older adults aged 65 or older. These findings can inform both technology developers and clinicians involved in the design, development and clinical implementation of digital health technologies for elderly citizens.
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Affiliation(s)
- Sofia Daniolou
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, University of Bern, Bern, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Schick T, Lorés-Motta L, Altay L, Fritsche LG, den Hollander AI, Fauser S. The Effect of Genetic Variants Associated With Age-Related Macular Degeneration Varies With Age. Invest Ophthalmol Vis Sci 2020; 61:17. [PMID: 33320170 PMCID: PMC7745630 DOI: 10.1167/iovs.61.14.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The prevalence of age-related macular degeneration (AMD) increases dramatically with age. This large collaborative study investigates the effects of 51 late-AMD-associated genetic variants in different ages, focusing on individuals above the age of 90 years. Methods The study included 27,996 individuals of the International AMD Genomics Consortium; 14,539 showed late AMD (51.9%) and 13,457 were controls (48.1%). Four age groups were compiled: 60 to 69 years, n = 6514, AMD = 2210 (33.9%); 70 to 79 years, n = 12228, AMD = 6217 (51.7%); 80 to 89 years, n = 8285, AMD = 5326 (64.3%); and ≥90 years, n = 969, AMD = 686 (70.8%). The effect sizes of 51 AMD-associated genetic variants were calculated for all age groups and were compared among the age groups. Results Six variants were associated with late AMD in individuals ≥ 90 years of age (P ≤ 0.0006). For rs10922109 and rs570618 (both in CFH), the minor allele (MA) was protective, and minor allele frequency (MAF) increased with age in cases and controls. For rs116503776 in C2/CFB/SKIV2L, the MA was protective, and MAF increased in cases. For rs3750846 in ARMS2/HTRA1, the MA increased risk, and MAF was lower in cases with increasing age. For rs6565597 in NPLOC4/TSPAN10, the MA increased risk. For rs5754227 in SYN3/TIMP3, the MA was protective, and there was no consistent variation in MAF with age. Variants in CFH and ARMS2 showed lower effect sizes at greater age. Interaction analysis showed strong age-related effects for rs570618 (P = 2.24 × 10-7) and rs3750846 (P = 0.001). Total genetic risk was lower in individuals ≥ 90 years old (area under the curve [AUC], 0.795) than in those 70 to 79 years old (AUC, 0.831; P = 0.03). Conclusions Effect sizes and MAF of genetic risk factors for late AMD differed among the age groups. These results could guide future work on AMD risk assessment in older individuals.
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Affiliation(s)
- Tina Schick
- AugenZentrum Siegburg, MVZ ADTC Siegburg GmbH, Siegburg, Germany.,Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Laura Lorés-Motta
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lebriz Altay
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Lars G Fritsche
- Center for Statistical Genetics, Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | - Anneke I den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,F. Hoffmann-La Roche, Basel, Switzerland
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Zhu Z, Wang W, Keel S, Zhang J, He M. Association of Age-Related Macular Degeneration With Risk of All-Cause and Specific-Cause Mortality in the National Health and Nutrition Examination Survey, 2005 to 2008. JAMA Ophthalmol 2019; 137:248-257. [PMID: 30570662 PMCID: PMC6439709 DOI: 10.1001/jamaophthalmol.2018.6150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question What is the association of age-related macular degeneration with mortality outcomes among older adults? Findings In this cohort study of 5603 participants 40 years or older, only late age-related macular degeneration was associated with more than a doubling of all-cause mortality and more than 3-fold higher risk of mortality not due to cardiovascular disease and cancer. Meaning The association of late age-related macular degeneration and poor survival may shed light on mechanisms underlying the disease, indicating that late age-related macular degeneration may be a marker of frailty and aging or may be due to residual confounding factors indicative of aging. Importance Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment and blindness in the United States if subretinal neovascularization is left untreated. Knowledge of the association between AMD and survival is informative for underlying mechanisms of AMD. Objective To examine the association between AMD and risk of all-cause and specific-cause mortality in a representative US sample. Design, Setting, and Participants This population-based prospective cohort study included 5603 participants 40 years or older who responded to the National Health and Nutrition Examination Survey (NHANES) in the 2005-2008 phase. Retinal photographs were graded as early, late, or no AMD. All analyses accounted for the complex and stratified design of NHANES with weighted data. Risks of all-cause mortality were assessed with Cox proportional hazards regression models; risks of specific-cause mortality, with Fine and Gray competing risks regression models. Time to death was counted from baseline to date of death or December 31, 2011, whichever came first. Data analysis was conducted from April 1 through 30, 2018. Exposures Age-related macular degeneration status as determined by digital fundus images. Main Outcomes and Measures Mortality resulting from all causes and specific causes until December 31, 2011. Results Among the 5603 participants (52.6% female [n = 2793] and 77.1% white [n = 3017]; mean [SE] age, 56.4 [0.4] years), weighted prevalence of any AMD was 6.6%, with 386 (5.8%) having early AMD and 55 (0.8%) having late AMD. After a median follow-up of 4.5 years (interquartile range, 3.6-5.6 years), 433 (5.3%) died of all causes, of whom 361 (83.1%) had no AMD, 54 (11.5%) had signs of early AMD, 18 (5.4%) had signs of late AMD, and 72 (16.9%) had any AMD at baseline. Overall, unadjusted all-cause and specific-cause mortality rates were higher for those participants who had early, late, or any AMD compared with no AMD. However, after adjusting confounding factors, only late AMD was associated with more than a doubling of all-cause mortality (hazard ratio [HR], 2.01; 95% CI, 1.00-4.03) and more than a 3-fold higher risk of mortality due to causes other than cardiovascular disease and cancer (HR, 3.42; 95% CI, 1.38-8.49). No association was identified between AMD presence or early AMD and all-cause or specific-cause mortality. Conclusions and Relevance In this study’s findings, only late AMD was independently associated with all-cause mortality and mortality due to causes other than cardiovascular disease and cancer, indicating that late AMD may be a marker of biological aging. Alternatively, this association may be due to unmeasured or inadequately assessed confounding factors for late AMD.
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Affiliation(s)
- Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Stuart Keel
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Blasiak J, Watala C, Tuuminen R, Kivinen N, Koskela A, Uusitalo-Järvinen H, Tuulonen A, Winiarczyk M, Mackiewicz J, Zmorzyński S, Filip A, Kaarniranta K. Expression of VEGFA-regulating miRNAs and mortality in wet AMD. J Cell Mol Med 2019; 23:8464-8471. [PMID: 31633290 PMCID: PMC6850949 DOI: 10.1111/jcmm.14731] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022] Open
Abstract
MicroRNAs (miRNAs) regulate gene expression; many of them act in the retinal pigment epithelium (RPE), and RPE degeneration is known to be a critical factor in age‐related macular degeneration (AMD). Repeated injections with anti‐VEGFA (vascular endothelial growth factor A) are the only effective therapy in wet AMD. We investigated the correlation between the expression of 18 miRNAs involved in the regulation of the VEGFA gene in serum of 76 wet AMD patients and 70 controls. Efficacy of anti‐VEGFA treatment was evaluated by counting the number of injections delivered up to 12 years. In addition, we compared the relative numbers of deaths in patient with AMD and control groups. We observed a decreased expression of miR‐34‐5p, miR‐126‐3p, miR‐145‐5p and miR‐205‐5p in wet AMD patients as compared with controls. These miRNAs are involved in the regulation of angiogenesis, cytoprotection and protein clearance. No miRNA was significantly correlated with the treatment outcome. Wet AMD patients had greater mortality than controls, and their survival was inversely associated with the number of anti‐VEGFA injections per year. No association was observed between miRNA expression and mortality. Our study emphasizes the need to clarify the role of miRNA regulation in AMD pathogenesis.
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Affiliation(s)
- Janusz Blasiak
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Cezary Watala
- Department of Haemostatic Disorders, Medical University, Lodz, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Niko Kivinen
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland
| | - Ali Koskela
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland
| | | | - Anja Tuulonen
- Department of Ophthalmology, Tampere University Hospital, Tampere, Finland
| | - Mateusz Winiarczyk
- Department of Vitreoretinal Surgery, Medical University of Lublin, Lublin, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, Lublin, Poland
| | - Szymon Zmorzyński
- Department of Cancer Genetics, Medical University of Lublin, Lublin, Poland
| | - Agata Filip
- Department of Cancer Genetics, Medical University of Lublin, Lublin, Poland
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland, Kuopio, Finland.,Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland
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Bian W, Wan J, Tan M, Wu X, Su J, Wang L. Patient experience of treatment decision making for wet age-related macular degeneration disease: a qualitative study in China. BMJ Open 2019; 9:e031020. [PMID: 31481567 PMCID: PMC6731856 DOI: 10.1136/bmjopen-2019-031020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the experience of patients with wet age-related macular degeneration (wAMD) in treatment decision-making process. DESIGN A descriptive qualitative study was designed by using semistructured interviews, and the data analysis was conducted with the thematic analysis approach. PARTICIPANTS AND SETTING A convenient and purposive sample of 21 participants diagnosed with wAMD was recruited from May 2018 to September 2018. The study was conducted in the Eye Clinic of Southwest Hospital of Army Medical University in Chongqing located in the southwest of China. RESULTS The mean age of the participants was 64.48 years (ranging 50-81 years), and the duration of the disease ranged from 6 months to 48 months. Four major themes were identified from the original data analysis. These themes included facing the darkness (choosing from light and darkness and living in pain), constraints on decision making (doctor-oriented decision making, inadequacy of options and time), weighing alternatives (family influence, financial burden and maintaining social function) and decision-making support (professional decision-making assistance and peer support). CONCLUSION This is a qualitative study attempting to explore the patient experience of treatment decision making for wAMD disease in China. Previous literature has focused on treatment effect and symptoms, rather than the individual experience and the wide contexts from a sociocultural perspective. Further studies, such as cross-sectional studies, can be used to describe the status and determine the influencing factors of decision0making process, so as to develop an impact factor model of decision making and to formulate an intervention for patients with wAMD.
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Affiliation(s)
- Wei Bian
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Junli Wan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Mingqiong Tan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xiaoqing Wu
- Outpatient Department of Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Jun Su
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Amy Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Lihua Wang
- Admin Office of Southwest Hospital, Army Medical University, Chongqing, China
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Kuper H, Mathenge W, Macleod D, Foster A, Gichangi M, Rono H, Wing K, Weiss HA, Bastawrous A, Burton M. Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya. BMJ Open 2019; 9:e029700. [PMID: 31182456 PMCID: PMC6561440 DOI: 10.1136/bmjopen-2019-029700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/04/2019] [Accepted: 05/15/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To estimate the association between (1) visual impairment (VI) and (2) eye disease and 6-year mortality risk within a cohort of elderly Kenyan people. DESIGN, SETTING AND PARTICIPANTS The baseline of the Nakuru Posterior Segment Eye Disease Study was formed from a population-based survey of 4318 participants aged ≥50 years, enrolled in 2007-2008. Ophthalmic and anthropometric examinations were undertaken on all participants at baseline, and a questionnaire was administered, including medical and ophthalmic history. Participants were retraced in 2013-2014 for a second examination. Vital status was recorded for all participants through information from community members. Cumulative incidence of mortality, and its relationship with baseline VI and types of eye disease was estimated. Inverse probability weighting was used to adjust for non-participation. PRIMARY OUTCOME MEASURES Cumulative incidence of mortality in relation to VI level at baseline. RESULTS Of the baseline sample, 2170 (50%) were re-examined at follow-up and 407 (10%) were known to have died (adjusted risk of 11.9% over 6 years). Compared to those with normal vision (visual acuity (VA) ≥6/12, risk=9.7%), the 6-year mortality risk was higher among people with VI (<6/18 to ≥6/60; risk=28.3%; risk ratio (RR) 1.75, 95% CI 1.28 to 2.40) or severe VI (SVI)/blindness (<6/60; risk=34.9%; RR 1.98, 95% CI 1.04 to 3.80). These associations remained after adjustment for non-communicable disease (NCD) risk factors (mortality: RR 1.56, 95% CI 1.14 to 2.15; SVI/blind: RR 1.46, 95% CI 0.80 to 2.68). Mortality risk was also associated with presence of diabetic retinopathy at baseline (RR 3.18, 95% CI 1.98 to 5.09), cataract (RR 1.26, 95% CI 0.95 to 1.66) and presence of both cataract and VI (RR 1.57, 95% CI 1.24 to 1.98). Mortality risk was higher among people with age-related macular degeneration at baseline (with or without VI), compared with those without (RR 1.42, 95% CI 0.91 to 2.22 and RR 1.34, 95% CI 0.99 to 1.81, respectively). CONCLUSIONS Visual acuity was related to 6-year mortality risk in this cohort of elderly Kenyan people, potentially because both VI and mortality are related to ageing and risk factors for NCD.
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Affiliation(s)
- Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr. Agarwal’s Eye Hospital, Kigali, Rwanda
| | - David Macleod
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Hillary Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Kitale Eye Unit, Ministry of Health Trans Nzoia County, Kitale, Kenya
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Anne Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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Hernandez L, Lanitis T, Cele C, Toro-Diaz H, Gibson A, Kuznik A. Intravitreal Aflibercept Versus Ranibizumab for Wet Age-Related Macular Degeneration: A Cost-Effectiveness Analysis. J Manag Care Spec Pharm 2018; 24:608-616. [PMID: 29952707 PMCID: PMC10397814 DOI: 10.18553/jmcp.2018.24.7.608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of vision loss in the United States. The most severe vision loss occurs in patients with neovascular AMD, known as wet AMD (wAMD). The most commonly used antivascular endothelial growth factor (VEGF) therapies approved by the FDA to treat patients with wAMD are ranibizumab, 0.5 mg administered by intravitreal injection once a month (approximately every 28 days), and intravitreal aflibercept injection (IAI), 2 mg every 4 weeks (monthly) for the first 12 weeks (3 months), followed by IAI 2 mg once every 8 weeks (2 months). Given the similar efficacy and safety profiles between IAI and ranibizumab, their associated costs and comparative cost-effectiveness are key factors in determining which one represents a more rational investment of scarce health care resources to help address the increasing cost of prescription drugs in the United States, a source of concern for patients, prescribers, payers, and policymakers. OBJECTIVE To assess the cost-effectiveness of intravitreal aflibercept injection 2 mg every 8 weeks after 3 initial monthly doses (IAI 2q8) versus ranibizumab 0.5 mg monthly (Rq4) and pro re nata (PRN) in the treatment of patients with wAMD from a U.S. payer perspective. METHODS A Markov cohort model was developed to estimate the lifetime quality-adjusted life-years (QALYs) and costs of treating patients with wAMD with IAI 2q8, Rq4, and ranibizumab PRN. The model considered changes in best-corrected visual acuity in the affected and fellow eyes over time, and the effect of blindness on mortality. Efficacy for IAI 2q8 and Rq4 was from VIEW 1 and VIEW 2 studies and from the Comparison of AMD Treatments Trials for ranibizumab PRN. Utilities and costs (in 2016 U.S. dollars) were from published literature. Health outcomes and costs were discounted at an annual rate of 3%. RESULTS Over a lifetime, IAI 2q8 provided equal health benefits with Rq4 (5.44 QALYs) at a lower total cost ($33,745 vs. $48,031) as a result of fewer injections. IAI 2q8 yielded slightly greater QALYs versus ranibizumab PRN (5.44 vs. 5.40) at a slightly higher cost ($33,745 vs. $33,652), with an incremental cost per QALY gained of $2,583. Results were sensitive to variations in drug acquisition costs and number of injections of both drugs and the baseline age of the cohort. CONCLUSIONS IAI 2q8 can be cost saving and cost-effective compared with Rq4 and ranibizumab PRN for the treatment of wAMD in the United States. DISCLOSURES This study was funded by Regeneron Pharmaceuticals, the manufacturer of aflibercept. Hernandez, Lanitis, Cele, and Toro-Diaz are employed by Evidera, which received funding from Regeneron Pharmaceuticals to conduct this study. Gibson and Kuznik are employed by and own stock in Regeneron Pharmaceuticals.
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Affiliation(s)
- Luis Hernandez
- Modeling and Simulation, Evidera, Waltham, Massachusetts
| | - Tereza Lanitis
- Modeling and Simulation, Evidera, London, United Kingdom
| | - Clifford Cele
- Modeling and Simulation, Evidera, Waltham, Massachusetts
| | | | - Andrea Gibson
- Medical Affairs Ophthalmology, Regeneron Pharmaceuticals, Tarrytown, New York
| | - Andreas Kuznik
- Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, New York
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Papudesu C, Clemons TE, Agrón E, Chew EY. Association of Mortality with Ocular Diseases and Visual Impairment in the Age-Related Eye Disease Study 2: Age-Related Eye Disease Study 2 Report Number 13. Ophthalmology 2018; 125:512-521. [PMID: 29153456 PMCID: PMC5866182 DOI: 10.1016/j.ophtha.2017.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the association of mortality with visual acuity (VA) impairment, age-related macular degeneration (AMD), and cataract surgery. DESIGN Cohort study. PARTICIPANTS Participants with at least intermediate AMD enrolled in a randomized controlled clinical trial of lutein/zeaxanthin and/or omega-3 fatty acids, the Age-Related Eye Disease Study 2 (AREDS2), for treatment of AMD and cataract. METHODS Baseline and annual eye examinations included best-corrected visual acuity (BCVA) assessments, slit-lamp examinations, and stereoscopic fundus photographs that were centrally graded for development of late AMD (central geographic atrophy or neovascular AMD) or pseudophakia. Cause-specific mortality was determined on the basis of the International Classification of Diseases 9th or 10th Revision codes. Risk of all-cause and cause-specific mortality was assessed with Cox proportional hazards models adjusted for age, sex, AMD severity, VA, history of cataract surgery, and assigned AREDS2 study treatment. Analyses included baseline covariates: race, education, smoking status, diabetes, and cardiovascular disease. RESULTS During follow-up (median 5 years), 368 (9%) of the 4203 AREDS2 participants died. Participants with neovascular AMD in 1 eye at baseline had a statistically significant increased risk for mortality compared with participants with no or few drusen (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.21-2.01; P < 0.001). Poorer survival was associated with bilateral cataract surgery before enrollment compared with baseline bilateral phakia (HR, 1.63; 95% CI, 1.29-2.07; P < 0.001) and with BCVA of less than 20/40 compared with participants with 20/40 or better (HR, 1.56; 95% CI, 1.06-2.30; P = 0.024), adjusted for age, sex, and statistically significant covariates. Participants who received antivascular endothelial growth factor therapies for neovascular AMD had decreased mortality compared with those who did not (HR, 0.71; 95% CI, 0.57-0.88; P = 0.002). The association between all-cause mortality and AREDS2 treatment whether assessing the main or individual treatment effect was not significantly different (omega-3 fatty acids main effect HR, 1.18; 95% CI, 0.96-1.45; P = 0.12; lutein/zeaxanthin main effect HR, 1.04; 95% CI, 0.85-1.28; P = 0.71). CONCLUSIONS In AREDS2, the presence of late AMD, bilateral cataract surgery, and VA less than 20/40 was associated with decreased survival. However, oral supplementation with omega-3 fatty acids, lutein plus zeaxanthin, zinc, or beta-carotene had no statistically significant impact on mortality.
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Affiliation(s)
- Chandana Papudesu
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | | | - Elvira Agrón
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland.
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Hernandez L, Lanitis T, Cele C, Toro-Diaz H, Gibson A, Kuznik A. Intravitreal Aflibercept Versus Ranibizumab for Wet Age-Related Macular Degeneration: A Cost-effectiveness Analysis. J Manag Care Spec Pharm 2018:1-9. [PMID: 29451077 DOI: 10.18553/jmcp.2018.17416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of vision loss in the United States. The most severe vision loss occurs in patients with neovascular AMD, known as wet AMD (wAMD). The most commonly used antivascular endothelial growth factor (VEGF) therapies approved by the FDA to treat patients with wAMD are ranibizumab, 0.5 mg administered by intravitreal injection once a month (approximately every 28 days), and intravitreal aflibercept injection (IAI), 2 mg every 4 weeks (monthly) for the first 12 weeks (3 months), followed by IAI 2 mg once every 8 weeks (2 months). Given the similar efficacy and safety profiles between IAI and ranibizumab, their associated costs and comparative cost-effectiveness are key factors in determining which one represents a more rational investment of scarce health care resources to help address the increasing cost of prescription drugs in the United States, a source of concern for patients, prescribers, payers, and policymakers. OBJECTIVE To assess the cost-effectiveness of intravitreal aflibercept injection 2 mg every 8 weeks after 3 initial monthly doses (IAI 2q8) versus ranibizumab 0.5 mg monthly (Rq4) and pro re nata (PRN) in the treatment of patients with wAMD from a U.S. payer perspective. METHODS A Markov cohort model was developed to estimate the lifetime quality-adjusted life-years (QALYs) and costs of treating patients with wAMD with IAI 2q8, Rq4, and ranibizumab PRN. The model considered changes in best-corrected visual acuity in the affected and fellow eyes over time, and the effect of blindness on mortality. Efficacy for IAI 2q8 and Rq4 was from VIEW 1 and VIEW 2 studies and from the Comparison of AMD Treatments Trials for ranibizumab PRN. Utilities and costs (in 2016 U.S. dollars) were from published literature. Health outcomes and costs were discounted at an annual rate of 3%. RESULTS Over a lifetime, IAI 2q8 provided equal health benefits with Rq4 (5.44 QALYs) at a lower total cost ($33,745 vs. $48,031) as a result of fewer injections. IAI 2q8 yielded slightly greater QALYs versus ranibizumab PRN (5.44 vs. 5.40) at a slightly higher cost ($33,745 vs. $33,652), with an incremental cost per QALY gained of $2,583. Results were sensitive to variations in drug acquisition costs and number of injections of both drugs and the baseline age of the cohort. CONCLUSIONS IAI 2q8 can be cost saving and cost-effective compared with Rq4 and ranibizumab PRN for the treatment of wAMD in the United States. DISCLOSURES This study was funded by Regeneron Pharmaceuticals, the manufacturer of aflibercept. Hernandez, Lanitis, Cele, and Toro-Diaz are employed by Evidera, which received funding from Regeneron Pharmaceuticals to conduct this study. Gibson and Kuznik are employed by and own stock in Regeneron Pharmaceuticals. Study concept and design were contributed by Hernandez, Lanitis, Kuznik, and Toro-Diaz. Cele, Toro-Diaz, and Lanitis took the lead in data collection, with assistance from the other authors. Data interpretation was performed by Cele, Toro-Diaz, Hernandez, Lanitis, and Kuznik. The manuscript was written by Hernandez, Lanitis, Gibson, Kuznik, and Cele and revised by Hernandez, Gibson, Kuznik, and Lanitis.
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Affiliation(s)
- Luis Hernandez
- 1 Modeling and Simulation, Evidera, Waltham, Massachusetts
| | - Tereza Lanitis
- 2 Modeling and Simulation, Evidera, London, United Kingdom
| | - Clifford Cele
- 1 Modeling and Simulation, Evidera, Waltham, Massachusetts
| | | | - Andrea Gibson
- 3 Medical Affairs Ophthalmology, Regeneron Pharmaceuticals, Tarrytown, New York
| | - Andreas Kuznik
- 4 Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, New York
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Hanhart J, Comaneshter DS, Freier Dror Y, Vinker S. Mortality in patients treated with intravitreal bevacizumab for age-related macular degeneration. BMC Ophthalmol 2017; 17:189. [PMID: 29017506 PMCID: PMC5635499 DOI: 10.1186/s12886-017-0586-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 10/03/2017] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study is to analyze mortality in patients treated with bevacizumab for wet AMD. Methods We conducted a retrospective case-control study between patients who received intravitreal injections of bevacizumab as the sole treatment for exudative AMD between September 2008 and October 2014 (n = 5385) and age and gender matched controls (n = 10,756). All individuals included in the study were reviewed for sociodemographic data and comorbidities. Survival analysis was performed using adjusted Cox regression, using relevant adjusted variables. Results During follow-up (maximum: 73 months), 1063 (19.7%) individuals after bevacizumab died compared with 1298 (12.1%) in the control group (P < .001). After adjusted Cox survival regression, mortality differed significantly between the groups, Odds ratio = 1.69, (95% C.I. 1.54–1.84), P < .001. Conclusions We found an increased long-term mortality in individuals with wet AMD treated with bevacizumab compared to a same age and gender group without wet AMD.
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Affiliation(s)
- Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical Center, 12 Beyt Street, 91031, Jerusalem, Israel.
| | | | | | - Shlomo Vinker
- Central Headquarters, Clalit Health Services, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Sun Y, Wang A, Liu X, Su Z, Li J, Luo Y, Chen S, Wang J, Li X, Zhao Z, Zhu H, Wu S, Guo X. Changes in Proteinuria on the Risk of All-Cause Mortality in People with Diabetes or Prediabetes: A Prospective Cohort Study. J Diabetes Res 2017; 2017:8368513. [PMID: 29090222 PMCID: PMC5635464 DOI: 10.1155/2017/8368513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 09/07/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Proteinuria has been related to all-cause mortality, showing regression or progression. However, few studies have focused on the relationship between proteinuria changes and all-cause mortality. The main purpose of this paper is to examine the associations between proteinuria changes and all-cause mortality in people with diabetes or prediabetes. METHODS Dipstick proteinuria at baseline and a 2-year follow-up were determined in the participants attending the Kailuan prospective cohort study. Participants were then divided into three categories: elevated proteinuria, stable proteinuria, and reduced proteinuria. Four Cox proportional hazard models were built to access the relations of proteinuria changes to all-cause mortality, adjusting for other confounding covariates. RESULTS A total of 17,878 participants were finally included in this study. There were 1193 deaths after a median follow-up of 6.69 years. After adjusting for major covariates and proteinuria at baseline, mortality risk was significantly associated with elevated proteinuria (hazard ratio (HR): 1.54, 95% confidence interval (CI): 1.33-1.79) and reduced proteinuria (HR: 0.70, 95% CI: 0.55-0.89), compared to those with stable proteinuria. CONCLUSION Proteinuria changes were independently associated with mortality risk in either diabetic or prediabetic population.
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Affiliation(s)
- Yang Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Zhaoping Su
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junjuan Li
- Department of Nephrology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Jianli Wang
- Department of Rehabilitation, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Zhan Zhao
- State Key Laboratory of Transducer Technology, Institute of Electronics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
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Age-related macular degeneration and mortality: the Melbourne Collaborative Cohort Study. Eye (Lond) 2017; 31:1345-1357. [PMID: 28820184 DOI: 10.1038/eye.2017.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/02/2017] [Indexed: 12/29/2022] Open
Abstract
AimsTo assess associations between features of age-related macular degeneration (AMD) and mortality.MethodsA total of 21 129 participants from the Melbourne Collaborative Cohort Study aged 47-85 years (60% female) were assessed for AMD (2003-2007). Mortality data to December 31, 2012 were obtained through linkage with the National Death Index. Associations were assessed using Cox regression, adjusting for age, sex, smoking, region of birth, education, physical activity, diet and alcohol.ResultsLate AMD was identified in 122 (0.6%) participants, including those with choroidal neovascularisation (n=55, 0.3%), geographic atrophy (n=87, 0.4%) and reticular pseudodrusen (n=87, 0.4%). After a median follow-up period of 8.1 years, 1669 (8%) participants had died, including those from cardiovascular diseases (386), tobacco-related cancers (179), and neurodegenerative disease (157). There was evidence of an increased rate of all-cause mortality for those with choroidal neovascularisation (Hazard Ratio (HR) 1.71 95% CI 1.06-2.76) and geographic atrophy (HR 1.46 95% CI 0.99-2.16). Choroidal neovascularisation was also associated with an increased rate of cardiovascular mortality (HR 3.16 95% CI 1.62-6.15) and geographic atrophy was associated with an increased rate of death from tobacco-related cancer (HR 2.86 95% CI 1.15-7.09). Weak evidence was also present for an association between choroidal neovascularisation and death from neurodegenerative disease (HR 2.49 95% CI 0.79-7.85). Neither reticular pseudodrusen nor the earlier stages of AMD were associated with mortality.ConclusionsLate AMD is associated with an increased rate of all-cause mortality. Choroidal neovascularisation and geographic atrophy were associated with death from cardiovascular disease and tobacco-related cancer, respectively.
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AGE-RELATED MACULAR DEGENERATION AND THE RISK OF ALL-CAUSE AND CARDIOVASCULAR MORTALITY: A Meta-Analysis of Cohort Studies. Retina 2017; 38:497-507. [PMID: 28665868 DOI: 10.1097/iae.0000000000001741] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE We evaluated the association between age-related macular degeneration (AMD) and the risk of all-cause and cardiovascular mortality by meta-analyses of data from prospective studies. METHODS A literature search was performed in PubMed, Web of Science, Embase, Cocharne Library, and China National Knowledge Infrastructure for relevant articles published up to December 2016. We estimated hazard ratios with 95% confidence intervals with fixed-effect models and conducted meta-regression to explore the potential sources of heterogeneity. Small-study effect was estimated by Egger's test and funnel plot. RESULTS We identified 13 population-based prospective cohort studies that examined the relationship between AMD and all-cause and cardiovascular mortality. Overall, the hazard ratios (95% confidence intervals) of all-cause mortality and cardiovascular mortality associated with any AMD were 1.15 (1.05-1.27) and 1.05 (95% confidence intervals: 0.87-1.26), respectively. The risk of all-cause mortality and cardiovascular mortality associated with early AMD were 1.08 (1.00-1.18) and 1.05 (0.89-1.24), and the associations with late AMD were 1.23 (1.11-1.36) and 1.28 (1.04-1.57), respectively. No evidence of small-study effect was found. CONCLUSION This meta-analysis indicated that AMD, especially late AMD, was associated with increased risk of all-cause mortality and cardiovascular mortality based on comparisons with people who did not have AMD and who were of similar age and sex.
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The Association between Age-Related Macular Degeneration and the Risk of Mortality. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3489603. [PMID: 28607930 PMCID: PMC5451765 DOI: 10.1155/2017/3489603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 12/22/2022]
Abstract
Studies have investigated the association between age-related macular degeneration (AMD) and subsequent risks of mortality, but results have been equivocal. We conducted a comprehensive analysis of prospective cohort studies to assess the association of AMD and the risk of mortality in the general population. We searched PubMed and EMBASE for trials published from 1980 to 2016. We included 11 cohort studies that reported relative risks with 95% confidence intervals for the association of AMD and mortality, involving 57,069 participants. In a random-effects model, the adjusted RR (95% confidence interval) associated with AMD was 1.09 (1.02-1.17) for all-cause mortality. Findings from this research provide support that persons with AMD had a higher subsequent risk of mortality than persons without AMD.
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McGuinness MB, Karahalios A, Finger RP, Guymer RH, Simpson JA. Age-Related Macular Degeneration and Mortality: A Systematic Review and Meta-Analysis. Ophthalmic Epidemiol 2017; 24:141-152. [DOI: 10.1080/09286586.2016.1259422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Myra B. McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Ophthalmology, University of Melbourne, East Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Robert P. Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Ophthalmology, University of Melbourne, East Melbourne, Australia
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Ophthalmology, University of Melbourne, East Melbourne, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Liu X, Yao Z. Insensitivity of PI3K/Akt/GSK3 signaling in peripheral blood mononuclear cells of age-related macular degeneration patients. J Biomed Res 2017; 31:248-255. [PMID: 28808220 PMCID: PMC5460613 DOI: 10.7555/jbr.31.20160096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Our recent studies with cultured retinal pigment epithelium cells suggested that overexpression of interleukin 17 receptor C (IL-17RC), a phenomenon observed in peripheral blood and chorioretinal tissues with age-related macular degeneration (AMD), was associated with altered activation of phosphatidylinositide 3-kinase (PI3K), Akt, and glycogen synthase kinase 3 (GSK3). We wondered whether or not altered PI3K, Akt, and GSK3 activities could be detected in peripheral blood mononuclear cells (PBMC) obtained from AMD patients. In the patients' PBMC, absent or reduced serine-phosphorylation of GSK3α or GSK3β was observed, which was accompanied with increased phosphorylation of GSK3 substrates (e.g. CCAAT enhancer binding protein α, insulin receptor substrate 1, and TAU), indicative of enhanced GSK3 activation. In addition, decreased protein mass of PI3K85α and tyrosine-phosphorylation of PI3K50α was present in PBMC of the AMD patients, suggesting impaired PI3K activation. Moreover, abnormally lowered molecular weight forms of Akt and GSK3 were detected in PBMC of the AMD patients. These data demonstrate that despite the presence of high levels of IL-17RC, Wnt-3a and vascular endothelial growth factor, the PI3K/Akt/GSK3 signaling pathway is insensitive to these stimuli in PBMC of the AMD patients. Thus, measurement of PI3K/Akt/GSK3 expression and activity in PBMC may serve as a surrogate biomarker for AMD.
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Affiliation(s)
- Xunxian Liu
- Department of Biochemistry, Microbiology and Immunology, Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Zemin Yao
- Department of Biochemistry, Microbiology and Immunology, Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
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Joslin CE, Vajaranant TS, Ulanski LJ. Age-Related Macular Degeneration and Mortality in the Age-Related Eye Disease Study (AREDS): The Effect of Sex and Time. Ophthalmol Retina 2017; 1:49-58. [PMID: 31047394 PMCID: PMC7433027 DOI: 10.1016/j.oret.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 06/09/2023]
Abstract
PURPOSE Age-related macular degeneration (AMD) shares similar risk factors and pathogeneses with cardiovascular diseases (CVDs). Epidemiologic studies over the past 2 decades analyzing the association between AMD and all-cause and CVD-specific mortality have failed to yield conclusive results. The purpose of this analysis is to investigate the sex-specific association between AMD and all-cause and CVD-specific mortality, and to assess whether duration of follow-up alters the strength of association. DESIGN The database of Genotypes and Phenotypes (dbGaP) data set for the Age-Related Eye Disease Study, a randomized clinical trial of high-dose antioxidants in AMD prevention, with participants enrolled from 1992 to 1998 and followed through 2005, was used in the analysis. PARTICIPANTS There were 4757 Age-Related Eye Disease Study participants aged 55 through 80 years (mean, 69.4 years; 44.1% male) recruited from 11 retinal specialty clinics. Participants had standard Age-Related Eye Disease Study AMD categories (category 1, n = 1117; category 2, n = 1062; category 3, n = 1621; category 4, n = 957). METHODS The sex-specific adjusted hazard ratio (HRadj) between baseline AMD and all-cause and CVD-specific mortality was determined at multiple time points (e.g., 5, 7, 10, and all years), adjusting for age, race, diabetes, hypertension, angina, cancer, smoking, obesity, clinical trial antioxidant treatment category, and education. MAIN OUTCOME MEASURES Sex-specific all-cause and CVD-specific mortality. RESULTS Mean follow-up was 9.6 years (range, 0.5-12.5 years), with 1087 deaths (category 1, n = 197 [17.6%]; category 2, n = 200 [18.8%]; category 3, n = 356 [22.0%]; category 4, n = 326 [34.1%]). Sex-stratified models demonstrated sex differences; in women, a significant association between AMD category 4 and all-cause mortality existed compared with category 1 at each period (HRadj, 1.5-2.3; all P ≤ 0.005); similar category 4 findings were present with CVD-specific mortality, strengthening with shorter periods (HRadj, 1.9-4.6; all P ≤ 0.01). Among men, a significant association between all AMD stages and all-cause (HRadj, 1.5-2.3; all P ≤ 0.05) and CVD-specific mortality (HRadj, 1.6-4.0; all P ≤ 0.05) existed for nearly all periods. CONCLUSIONS Substantial late AMD cases and deaths exceed those in previous population-based studies to better test mortality-related hypotheses. Age-related macular degeneration was significantly associated with all-cause and CVD-specific mortality. Relationships weakened over a longer duration of follow-up, and sex seems to modify the association. Future analyses are warranted to interrogate the possible clinical usefulness of these relationships.
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Affiliation(s)
- Charlotte E Joslin
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois; Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois.
| | - Thasarat S Vajaranant
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Lawrence J Ulanski
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
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Relation between Age-Related Macular Degeneration and Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8212063. [PMID: 28070519 PMCID: PMC5192308 DOI: 10.1155/2016/8212063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/27/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Abstract
Data on the association between age-related macular degeneration (AMD) and cardiovascular disease and mortality are conflicting. The purpose of this report is to conduct a systematic review to better understand the role of AMD as a risk factor for CVD events and mortality. We searched Medline (Ovid) and Embase (Ovid) for trials published from 1980 to 2015. We included 20 cohort studies that reported relative risks with 95% confidence intervals for the association of AMD and cardiovascular events and mortality, involving 29,964,334 participants. In a random-effects model, the adjusted RR (95% confidence interval [CI]) associated with AMD was 1.08 (1.00-1.117) for all-cause mortality (8 studies) and 1.18 (0.98-1.43) for cardiovascular disease mortality (5 studies). The pooled RR (95% CI) was 1.17 (0.94-1.45) for coronary heart disease (CHD; 3 studies) and 1.13 (0.93-1.36) for stroke (8 studies). Findings from this systematic review support that AMD is associated with increased risk of all-cause mortality. The evidence that AMD predicts incident CVD events or CVD mortality remains inclusive and warrants further study in the future.
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Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study. J Ophthalmol 2016; 2016:2707102. [PMID: 27830084 PMCID: PMC5088334 DOI: 10.1155/2016/2707102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/25/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose. To investigate whether patients with age-related macular degeneration (AMD) run a potentially higher risk of developing visual, musculoskeletal, and balance complaints than age-matched controls with normal vision. Methods. Visual assessments, self-rated visual function, self-rated visual, musculoskeletal, and balance complaints, and perceived general health were obtained in 37 AMD patients and 18 controls, at baseline and after an average of 3.8 years later. Results. At follow-up both groups reported decreased visual acuity (VA) and visual function, but only AMD patients reported significantly increased visual, musculoskeletal, and balance complaints. Decreased VA, need for larger font size when reading, need for larger magnification, and decreased self-rated visual function were identified as risk markers for increased complaints in AMD patients. These complaints were also identified as risk markers for decreased health. For controls, decreased VA and self-reported visual function were associated with increased visual and balance complaints. Conclusions. Visual deterioration was a risk marker for increased visual, musculoskeletal, balance, and health complaints in AMD patients. Specifically, magnifying visual aids, such as CCTV, were a risk marker for increased complaints in AMD patients. This calls for early and coordinated actions to treat and prevent visual, musculoskeletal, balance, and health complaints in AMD patients.
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Mining for genes related to choroidal neovascularization based on the shortest path algorithm and protein interaction information. Biochim Biophys Acta Gen Subj 2016; 1860:2740-9. [PMID: 26987808 DOI: 10.1016/j.bbagen.2016.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/05/2016] [Accepted: 03/10/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Choroidal neovascularization (CNV) is a serious eye disease that may cause visual loss, especially for older people. Many factors have been proven to induce this disease including age, gender, obesity, and so on. However, until now, we have had limited knowledge on CNV's pathogenic mechanism. Discovering the genes that underlie this disease and performing extensive studies on them can help us to understand how CNV occurs and design effective treatments. METHODS In this study, we designed a computational method to identify novel CNV-related genes in a large protein network constructed using the protein-protein interaction information in STRING. The candidate genes were first extracted from the shortest paths connecting any two known CNV-related genes and then filtered by a permutation test and using knowledge of their linkages to known CNV-related genes. RESULTS A list of putative CNV-related candidate genes was accessed by our method. These genes are deemed to have strong relationships with CNV. CONCLUSIONS Extensive analyses of several of the putative genes such as ANK1, ITGA4, CD44 and others indicate that they are related to specific biological processes involved in CNV, implying they may be novel CNV-related genes. GENERAL SIGNIFICANCE The newfound putative CNV-related genes may provide new insights into CNV and help design more effective treatments. This article is part of a Special Issue entitled "System Genetics" Guest Editor: Dr. Yudong Cai and Dr. Tao Huang.
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Creuzot‐Garcher C, Binquet C, Daniel S, Bretillon L, Acar N, Lazzer A, Arnould L, Tzourio C, Bron AM, Delcourt C. The Montrachet Study: study design, methodology and analysis of visual acuity and refractive errors in an elderly population. Acta Ophthalmol 2016; 94:e90-7. [PMID: 26466845 PMCID: PMC5057364 DOI: 10.1111/aos.12842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/04/2015] [Indexed: 12/16/2022]
Abstract
Purpose To describe the design of the Montrachet Study (Maculopathy Optic Nerve nuTRition neurovAsCular and HEarT diseases) and to report visual acuity and refractive errors in this elderly population. Methods Participants were recruited in Dijon (France), from the ongoing population‐based 3C Study. In 2009–2011, 1153 participants from the 3 Cities Study, aged 75 years or more, had an initial eye examination and were scheduled for eye examinations. The eye examination comprised visual acuity, refraction, visual field, ocular surface assessment, photographs and OCT of the macula and the optic disc, measurement of intra‐ocular pressure, central corneal thickness and macular pigment assessment. Information on cardiovascular and neurologic diseases and a large comprehensive database (blood samples, genetic testing, cognitive tests, MRI) were available from the 3C Study. Results Presenting visual acuity <20/60 in the better eye was found in 2.3% (95% CI 1.5–3.2) of the participants with no gender differences. Visual impairment increased with age from 1.5% (95% CI 0.3–2.7) for those aged 75–79 years to 5.6% (95% CI 2.9–8.4) for patients 85 years and older (p = 0.0003). Spherical equivalent did not differ between men and women (p = 0.8) and decreased with age whatever the lens status. Conclusion Despite the high prevalence of self‐reported eye diseases in this elderly population, visual impairment was low and increased with age. The Montrachet Study may help to better estimate the prevalence of eye diseases in people over 75 years of age and to seek associations with cardiovascular and neurologic diseases and their potential risk factors.
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Affiliation(s)
- Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- INRA UMR1324 Center for Taste and Feeding Behavior Dijon France
- CNRS UMR6265 Center for Taste and Feeding Behavior Dijon France
- Center for Taste and Feeding Behavior Burgundy University Dijon France
| | | | | | - Lionel Bretillon
- INRA UMR1324 Center for Taste and Feeding Behavior Dijon France
- CNRS UMR6265 Center for Taste and Feeding Behavior Dijon France
- Center for Taste and Feeding Behavior Burgundy University Dijon France
| | - Nyiazi Acar
- INRA UMR1324 Center for Taste and Feeding Behavior Dijon France
- CNRS UMR6265 Center for Taste and Feeding Behavior Dijon France
- Center for Taste and Feeding Behavior Burgundy University Dijon France
| | - Aurélie Lazzer
- Department of Ophthalmology University Hospital Dijon France
| | - Laurent Arnould
- Department of Ophthalmology University Hospital Dijon France
| | | | - Alain M. Bron
- Department of Ophthalmology University Hospital Dijon France
- INRA UMR1324 Center for Taste and Feeding Behavior Dijon France
- CNRS UMR6265 Center for Taste and Feeding Behavior Dijon France
- Center for Taste and Feeding Behavior Burgundy University Dijon France
| | - Cécile Delcourt
- INSERM Centre INSERM U897 Univ Bordeaux, ISPED Bordeaux France
- INSERM, Center INSERM U897‐Epidemiology‐Biostatistics Bordeaux France
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Gopinath B, Liew G, Burlutsky G, Mitchell P. Age-related macular degeneration and risk of total and cause-specific mortality over 15 years. Maturitas 2015; 84:63-7. [PMID: 26596903 DOI: 10.1016/j.maturitas.2015.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to investigate the independent association between AMD and risk of ischemic heart disease (IHD), stroke, and cardiovascular (CVD) mortality, and all-cause mortality over 15 years. METHODS 3654 participants aged 49+ years at baseline were followed over 15 years. AMD was assessed from retinal photographs. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using Cox models. RESULTS 71.4% (n=162) and 34.6% (n=1037) of participants with any AMD and no AMD, respectively, died over 15 years. After multivariable-adjustment, no significant associations were observed between AMD and total- and cause-specific mortality in the overall cohort. However, among men, late AMD at baseline was associated with an increased risk of all-cause mortality (n=22; 95.7%), 15 years later: multivariable-adjusted HR, 1.80 (95% CI 1.04-3.11). Women with late AMD had 2-fold increased risk of stroke mortality (n=15; 28.9%), HR 2.10 (95% CI 1.08-4.06). Early-stage AMD was not associated with mortality risk. CONCLUSION Late AMD independently predicted all-cause mortality in men and stroke mortality in women, over 15 years. Although underlying mechanisms are unclear, these findings indicate that late AMD is a marker of biological aging.
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Affiliation(s)
- Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia.
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia
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