Tien Yin Wong, MD, MPH, PhD; Ronald Klein, MD, MPH; Cong Sun, MD, MPH; Paul Mitchell, MD, PhD; David J. Couper, PhD; Hong Lai, PhD; Larry D. Hubbard, MAT; A. Richey Sharrett, MD, DrPH; Atherosclerosis Risk in Communities Study
Acknowledgments: The authors thank the staff and participants of the Atherosclerosis Risk in Communities Study for their important contributions.
Potential Conflicts of Interest: None disclosed.
Grant Support: By National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. Additional support was provided by a Science Technology Innovation Grant from the State of Victoria. Dr. Wong was supported by a Clinical Investigator Award from the Sylvia and Charles Viertel Charitable Foundation.
Requests for Single Reprints: Tien Yin Wong, MD, MPH, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia; e-mail, email@example.com.
Current Author Addresses: Dr. Wong: Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne 3002, Australia, and Singapore Eye Research Institute, National University of Singapore, 11 Third Hospital Avenue, Singapore.
Dr. Sun: Centre for Eye Research Australia, University of Melbourne, Australia.
Dr. Klein: Department of Ophthalmology, University of Wisconsin, 610 North Walnut Street, 4th Floor, Madison, WI 53726.
Dr. Mitchell: Department of Ophthalmology, University of Sydney, New South Wales 2006, Australia.
Dr. Couper: Department of Biostatistics, 137 East Franklin Street, Suite 203, Chapel Hill, NC 27599.
Dr. Lai: Wilmer Ophthalmological Institute, 600 North Wolfe Street, Johns Hopkins University, Baltimore, MD 21287.
Mr. Hubbard: Department of Ophthalmology, University of Wisconsin, 406 Science Drive, Suite 400, Madison, WI 53705.
Dr. Sharrett: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.
Author Contributions: Conception and design: T.Y. Wong, P. Mitchell, L.D. Hubbard, A.R. Sharrett.
Analysis and interpretation of the data: C. Sun, L.D. Hubbard, A.R. Sharrett.
Critical revision of the article for important intellectual content: T.Y. Wong, R. Klein, P. Mitchell, H. Lai, L.D. Hubbard, A.R. Sharrett.
Final approval of the article: T.Y. Wong, R. Klein, C. Sun, P. Mitchell, D.J. Couper, L.D. Hubbard.
Provision of study materials or patients: L.D. Hubbard.
Statistical expertise: D.J. Couper, H. Lai.
Obtaining of funding: L.D. Hubbard.
Administrative, technical, or logistic support: T.Y. Wong, L.D. Hubbard.
Collection and assembly of data: D.J. Couper, L.D. Hubbard.
Wong T., Klein R., Sun C., Mitchell P., Couper D., Lai H., Hubbard L., Sharrett A., ; Age-Related Macular Degeneration and Risk for Stroke. Ann Intern Med. 2006;145:98-106. doi: 10.7326/0003-4819-145-2-200607180-00007
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Published: Ann Intern Med. 2006;145(2):98-106.
Age-related macular degeneration (AMD) and stroke affect significant numbers of individuals older than 40 years of age in the United States (1-2). Research shows that AMD is the most common cause of blindness (1), whereas stroke is a leading cause of death, hospitalization, and severe neurologic disability (2). Both conditions are associated with poorer quality of life and increased socioeconomic burden.
Some investigators have suggested that AMD and stroke share common pathogenic mechanisms and risk factors (3). Epidemiologic studies show that individuals with cardiovascular risk factors, such as hypertension and cigarette smoking, are more likely to have AMD (4-8). Carotid artery disease, a well-established risk factor for stroke (9), has also been associated with AMD (10). Furthermore, emerging research suggests that inflammatory processes and the genes that code for some of these processes may be linked with both stroke and AMD (11-15).
Department of Anatomy II, Tsurumi University, School of Dental Medicine
August 4, 2006
AMD and stroke
To the Editor, Wong and colleagues concluded that age-related macular degeneration (AMD) is an independent risk factor for stroke (1). However, some information is missing.
Although the authors demonstrated that stroke-free survival rate in persons with early-stage AMD was higher than in those without early-stage AMD, they did not mention that the difference in such survival rate is statistically significant. In spite of 10 years follow-up, such survival rate difference shown in their report seems to be very small (1), suggesting that AMD seems not to be worth a predicting factor for clinical practices.
The authors did not provide information about serum levels of inflammatory biomarkers. Higher level of C-reactive protein (CRP) is independently associated with progression of AMD (2). CRP is also one of risk factors for ischemic stroke, independent of potential confounders (3). The analysis of inflammation states in eligible persons could affect the association between AMD and stroke.
(1) Wong TY, Klein R, Sun C, et al. Age-related macular degeneration and risk for stroke. Ann Intern Med 2006;145:98-106.
(2) Seddon JM, George S, Rosner B, et al. Progression of age-related macular degeneration: prospective assessment of C-reactive protein, interleukin 6, and other cardiovascular biomarkers. Arch Ophthalmol 2005;123:774-82.
(3) Woodward M, Lowe GD, Campbell DJ, et al. Associations of inflammatory and hemostatic variables with the risk of recurrent stroke. Stroke 2005;36:2143-7.
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