Macular Degeneration Tied to Stroke Risk (CME/CE)
The current study included 12,216 middle-age individuals (ages 45 to 64) who had retinal photographs taken at the third examination visit of the Atherosclerosis Risk in Communities ( ARIC) study.
Of those, 576 had early disease, defined as the presence of either soft drusen alone, retinal pigment epithelial depigmentation alone, or a combination of soft drusen with increased retinal pigment and/or retinal pigment epithelial depigmentation.
The rest had late disease, defined as the presence of exudative age-related macular degeneration or pure geographic atrophy.
Through follow-up, 619 of the participants (5.1%) had a stroke, including 548 cerebral infarctions, 57 intracerebral hemorrhages, and 14 subarachnoid hemorrhages.
Those with any age-related macular degeneration were about 50% more likely to have a stroke during follow-up (HR 1.51, 95% CI 1.11 to 2.06) after adjustment for age, sex, race, field center, mean arterial blood pressure, antihypertensive medications, fasting glucose, total cholesterol, HDL cholesterol, triglyceride levels, body mass index, atrial fibrillation, white blood cell count, cigarette smoking, and alcohol consumption.
The relationship was stronger for intracerebral hemorrhage (HR 2.64, 95% CI 1.18 to 5.87) than for ischemic stroke (HR 1.42, 95% CI 1.01 to 1.99).
"Recently, antivascular endothelial growth factor agents used in the treatment of neovascular age-related macular degeneration have been suggested to increase the risk of intracerebral hemorrhage," the authors noted.
"Based on our findings, it appears that patients with [the eye disease] may already be at an increased risk of intracerebral hemorrhage and, thus, antivascular endothelial growth factor therapy could potentially increase this risk further."
"However," they added, "additional studies are needed to confirm this potential side effect of antivascular endothelial growth factor agents."
They acknowledged some limitations of the study, including the fact that the technique used for taking retinal photographs makes grading age-related macular degeneration more variable, the use of pictures from only one eye for each participant, and the low number of patients with late age-related macular degeneration.
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts.