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AMD linked to heart attack and stroke

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AMD, heart disease and stroke are all diseases of survivors, which may explain risk levels and suggest new approaches to treatment

People who suffer from age-related macular degeneration (AMD), the most common eye disease in older people, are at greater risk of heart attack or stroke, according to a study published in the British Journal of Ophthalmology.

Researchers from the University of Sydney looked at over 3,600 people aged 49 and over. Participants were assessed for overall health and retinal photographs were used to establish any vision problems. Almost two thirds of the volunteers were reassessed after five years and nearly 2000 were examined again after 10 years.

What they found was that those people with early stage AMD at the start of the study had twice the risk of dying from a heart attack or stroke over the next 10 years. Those with more advanced AMD had a still greater risk.

This research supports previous studies linking AMD to cardiovascular conditions. However scientists are still unclear as to why such a link should exist. One reason may be that the conditions share a similar set of underlying causes. Problems such as the thickening of the arteries, tissue inflammation and damage caused by high blood pressure are known to increase the risk of getting any one of the three conditions looked at in the study. Smoking is a further risk factor shared across all the conditions.

But it might simply be that AMD is a sign of overall biological ageing – so that people with AMD are inevitably more prone to other diseases that are age-related. As Professor Paul Mitchell, who led the study, points out, 'Macular degeneration is a disease of survivors, so you have to live long enough to get it.'

But the study has raised further concerns about a possible link with the anti-VEGF drug treatments used for wet AMD. These drugs work by limiting the production of the protein that helps form new blood vessels. In patients with wet AMD these new blood vessels are unstable and tend to leak fluid and blood under the retina which causes scarring and can lead to blindness. Given the possible link with heart attack and stroke, the research raises questions about whether limiting new blood vessel growth could have a damaging effect on the wider cardiovascular system.

The Australian scientists that carried out the research, however, were keen to stress the relatively small size of their study and agreed further research was required before reviewing AMD treatments.

'This research should not alarm macular disease patients as we have been aware of such a link for a long time,' says Tom Bremridge, chief executive of the Macular Disease Society. 'Macular patients should be informed about the possible increased risk of cardiovascular problems, and followed up, if necessary, with heart checks. But there is no need for patients to make any further enquiries with their ophthalmologists or become at all alarmed.'

Shafiq Rehman, consultant ophthalmologist at the Yorkshire Eye Hospital agrees: 'I really don’t think that this research should give people cause for concern. I believe that in order to draw any definite conclusions we would need to see larger, more comprehensive studies.'

For those worried about the findings, Rehman highlights the positives for AMD sufferers if the link between the conditions is looked at another way, 'What is interesting about the information so far is that this could provide a potential opportunity for those with AMD. If we’re able to reduce the progression of AMD in these patients, we may also be able to reduce the chances of having a heart attack or stroke.'

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Information on this site is for interest only and is not a substitute for professional medical advice. You should consult your own doctor about any specific health concerns.

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