Age-Related Macular Degeneration and the Risk of Stroke – The Rotterdam Study
Renske G. Wieberdink, MD;
Lintje Ho, MD;
M. Kamran Ikram, MD, PhD;
Peter J. Koudstaal, MD, PhD;
Albert Hofman, MD, PhD;
Paulus T.V.M. de Jong, MD, PhD;
Johannes R. Vingerling, MD, PhD;
Monique M.B. Breteler, MD, PhD m.breteler at erasmusmc.nl
From the Departments of Epidemiology (R.G.W., L.H., M.K.I., A.H., J.R.V., M.M.B.B.), Neurology (R.G.W., M.K.I., P.J.K.), and Ophthalmology (L.H., M.K.I., J.R.V.), Erasmus Medical Center, Rotterdam, the Netherlands; the Department of Ophthalmology (P.T.V.M.d.J.), Academic Medical Center, Amsterdam, the Netherlands; and The Netherlands Institute for Neuroscience (P.T.V.M.d.J.), Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
Background and Purpose—Age-related macular degeneration (AMD) and stroke are both frequent diseases in the elderly. A link between AMD and stroke has been suggested, because both disorders have many risk factors in common. The aim of this study was to investigate the association between AMD and stroke and the subtypes cerebral infarction and intracerebral hemorrhage in the general elderly population.
Methods—This study was part of the population-based Rotterdam Study and included 6207 participants aged ?55 years who were stroke-free at baseline (1990 to 1993). Signs of AMD were assessed on fundus photographs at baseline and at regular follow-up examinations and were categorized in 5 stages (0 to 4) representing an increasing severity. Late AMD (Stage 4) was subdivided into dry and wet AMD. Follow-up for incident stroke was complete up to January 1, 2007. Data were analyzed using time-dependent Cox regression models adjusted for age, sex, and potential confounders.
Results—During a median follow-up of 13.6 years, 726 participants developed a stroke (397 cerebral infarction, 59 intracerebral hemorrhage, 270 unspecified). Late AMD was associated with an increased risk of any stroke (hazard ratio, 1.56; 95% CI, 1.08 to 2.26) due to a strong association with intracerebral hemorrhage (hazard ratio, 6.11; 95% CI, 2.34 to 15.98). In contrast, late AMD was not associated with cerebral infarction. Earlier AMD stages were not associated with risk of stroke or any of its subtypes.
Conclusions—We found that late AMD is strongly associated with intracerebral hemorrhage, but not with cerebral infarction, in the general elderly population.
Received February 4, 2011. Revision received February 25, 2011. Accepted March 8, 2011.
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Notice that both AMD and stroke are independently associated with low vitamin D
Wonder if lack of vitamin D might be a common cause
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