Age-related macular degeneration associated with serious forms of cardiovascular disease

Age-related macular degeneration associated with serious forms of cardiovascular disease

Age-related macular degeneration associated with serious forms of cardiovascular disease

Abstract: People with subretinal drusenoid deposits (SDD), a form of age-related macular degeneration, are more likely to have heart damage as a result of heart failure or heart attack or other forms of cardiovascular disease associated with an increased risk of stroke.

Source: Mount Sinai Hospital

Patients with a specific form of age-related macular degeneration (AMD), the leading cause of blindness in the United States, are also more likely to have either underlying heart damage from heart failure and heart attacks or advanced heart valve disease or carotid artery disease associated with certain types strokes, according to a new study from the New York Eye and Ear Infirmary of Mount Sinai.

This research, published on November 17 in BMJ Open Ophthalmologywas the first to identify which types of high-risk cardiovascular disease and carotid artery disease were associated with eye disorder.

The findings could prompt increased screening to preserve vision, diagnose undetected heart disease, and prevent adverse cardiovascular events.

“For the first time, we were able to link these specific high-risk cardiovascular diseases with a specific form of AMD, that with subretinal drusenoid deposits (SDDs),” explains lead author R. Theodore Smith, MD, Ph.D. ., professor of ophthalmology at the Icahn School of Medicine at Mount Sinai.

“This study is the first strong link between the leading cause of blindness, AMD, and heart disease, the leading cause of death worldwide. Furthermore, we also have solid evidence of what is actually happening: the blood flow to the eye is directly reduced by these diseases, either by heart damage that reduces blood flow throughout the body, or by a blocked carotid artery that directly impedes blood flow to the eye.

Poor blood supply can damage any part of the body, and in these specific diseases, the retina is damaged and SDD is left behind. Damage to the retina means loss of vision and can lead to blindness.”

AMD is the leading cause of vision impairment and blindness in people over the age of 65 and is the result of damage to the central area of ​​the retina called the macula, which is responsible for reading and controlling vision.

One major form of early AMD consists of small yellow deposits of cholesterol called drusen, which form under a part of the retina called the retinal pigment epithelium (RPE). They can deprive the retina of blood and oxygen, leading to vision loss. The formation of drusen can be slowed down with an appropriate vitamin supplement.

The other major form of early AMD, subretinal drusenoid deposits (SDD), is less well known and requires high-tech retinal imaging to detect. These deposits contain a different form of cholesterol, and form above the RPE, just below the light-sensitive cells of the retina, where damage and vision loss occur. There is no known treatment for SDD.

dr. Smith and a team of Mount Sinai researchers initially found that patients with cardiovascular disease or stroke were more likely to have SDD. This first research of its kind was published in the July issue of the journal Retina.

This new study extends that previous work, looking at a larger patient population, and identifies the specific severe forms of heart disease and carotid artery disease that caused SDD AMD.

Researchers analyzed the eyes of 200 AMD patients using retinal imaging to determine which patients had SDD. Patients answered a questionnaire about their history of cardiovascular disease. Of the 200 patients, 97 had SDD and 103 only drusen.

Forty-seven of the 200 had severe heart disease (19 had heart damage from heart failure or heart attack, 17 had serious valve disease, and 11 had a stroke arising from the carotid artery).

Forty out of 47 (86 percent) had SDD. In contrast, of 153 AMD patients who did not have these severe diseases, 57 had SDD (43 percent).

The researchers concluded that AMD patients with this severe cardiovascular disease and stroke were nine times more likely to have SDD than those without.

Age-related macular degeneration associated with serious forms of cardiovascular disease
AMD is the leading cause of vision impairment and blindness in people over the age of 65 and is the result of damage to the central area of ​​the retina called the macula, which is responsible for reading and controlling vision. The image is in the public domain

“This work demonstrates the fact that ophthalmologists may be the first physicians to detect systemic disease, particularly in asymptomatic patients,” says co-investigator Richard B. Rosen, MD, chief of retina services for the Mount Sinai Health System.

“The detection of SDD in the retina should trigger referral of the individual to a primary care provider, particularly if no previous cardiologist has been involved. It could prevent a life-threatening cardiac event.”

“This study opened the door to further productive multidisciplinary collaboration between ophthalmology, cardiology and neurology services,” says Jagat Narula, MD, Ph.D., director of the Cardiovascular Imaging Program at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai.

“We should also focus on defining disease severity with vascular imaging in cardiology and neurology clinics and evaluate their impact on AMD and SDD with retinal imaging.” In this way, we can find out which vascular patients should be referred for the detection and prevention of the blinding disease.”

About this vision and cardiovascular disease research news

Author: Press office
Source: Mount Sinai Hospital
Contact: Press Office – Mount Sinai Hospital
Picture: The image is in the public domain

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Original research: Open access.
Subretinal drusenoid deposits are strongly associated with the coexistence of high-risk vascular disease” by Gerard Ledesma-Gil et al. BMJ Open Ophthalmology


Abstract

Subretinal drusenoid deposits are strongly associated with the coexistence of high-risk vascular disease

Background/Goals

To demonstrate that subretinal drusenoid deposits (SDD) in age-related macular degeneration (AMD) are associated with coexisting high-risk vascular disease (HRVD).

Methods

A cross-sectional study. Two hundred AMD subjects (aged 51 to 100 years; 121 women, 79 men) were recruited. Spectral domain optical coherence tomography, autofluorescence and near-infrared reflective imaging and lipid profiles were obtained. Subjects were divided using a health history questionnaire into those with or without HRVD, defined as: heart valve defect (eg, aortic stenosis), myocardial defect (eg, myocardial infarction), and stroke/transient ischemic attack. Masked readers divided the subjects into two groups: SDD (with or without drusen) and drusen (only). Univariate testing was performed by χ2 test. We created multivariate regression models to test the relationship between coexisting HRVD and SDD status, lipid levels, and other covariates.

the results

The prevalence of HRVD was 41.2% (40/97) and 6.8% (7/103) in the SDD and non-SDD groups (correlation of SDD with HRVD, p=9 ×10-9OR 9.62, 95% CI 4.04 to 22.91). Multivariate regressions: only SDD and high-density lipoprotein (HDL) in the first two HDL quartiles remained significant for HRVD (p=9.8×10-5, 0.021, respectively). Multivariate regression model: SDD and HDL in Q1 or Q2 identified the presence of HRVD with an accuracy of 78.5%, 95% CI 72.2% to 84.0%.

Findings

High-risk cardiovascular and neurovascular diseases were accurately identified in the AMD cohort based on SDD and HDL levels. SDD may be associated with inadequate ocular perfusion resulting from systemic vasculopathies. Further research with this paradigm is warranted and may reduce mortality and morbidity from vascular disease.

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