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Age-Related Macular Degeneration and Risk for Stroke

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
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From University of Melbourne, Victoria, Australia; University of Wisconsin, Madison, Wisconsin; University of Sydney, Sydney, Australia; University of North Carolina, Chapel Hill, North Carolina; and Johns Hopkins University, Baltimore, Maryland.

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, twong@unimelb.edu.au.

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.

Ann Intern Med. 2006;145(2):98-106. doi:10.7326/0003-4819-145-2-200607180-00007
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There were 508 (4.9%) individuals with AMD in our sample. Of these, 498 (4.8%) had early-stage AMD and 10 (0.1%) had late-stage disease. As previously reported (19), the prevalence of early-stage AMD varied by study site. White patients in North Carolina and Maryland had the highest prevalence (5.6% and 5.4%, respectively), whereas African-American patients in Mississippi had the lowest prevalence (3.3%); the prevalence of early-stage AMD in the mixed sample from Minnesota was 4.5%.

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Stroke-free survival in participants with and without early-stage age-related macular degeneration (AMD), adjusted for age, sex, and ethnicity.
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Submit a Comment/Letter
AMD and stroke
Posted on August 4, 2006
Yujiro Kida
Department of Anatomy II, Tsurumi University, School of Dental Medicine
Conflict of Interest: None Declared

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.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Age-Related Macular Degeneration and Stroke

The summary below is from the full report titled “Age-Related Macular Degeneration and Risk for Stroke.” It is in the 18 July 2006 issue of Annals of Internal Medicine (volume 145, pages 98-106). The authors are T.Y. Wong, R. Klein, C. Sun, P. Mitchell, D.J. Couper, H. Lai, L.D. Hubbard, and A.R. Sharrett, for the Atherosclerosis Risk in Communities Study.


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