Age-Related Macular Degeneration With Visual Disability Is Associated With Cardiovascular Disease Risk in the Korean Nationwide Cohort

BACKGROUND: Age-related macular degeneration (AMD) is the leading cause of visual disability. AMD shares some risk factors with the pathogenesis of cardiovascular disease (CVD). However, previous studies examining the association between AMD and the risk of CVD provide conflicting results. Hence, we investigated the association between AMD, visual disability, and the risk of CVD. METHODS AND RESULTS: This is a nationwide cohort study using data from the Korean National Health Insurance System database (2009– 2019) on subjects who underwent a national health screening program in 2009. A total of 3 789 963 subjects were categorized by the presence of AMD and visual disability. Visual disability was defined as a best-corrected visual acuity of ≤20/100 by validated documentation from a specialist physician. Cox regression hazard model was used to examine the hazard ratios (HRs) of CVD, including myocardial infarction and ischemic stroke, after adjusting for potential confounders. During a mean 9.77 years of follow-up, AMD was associated with a 5% higher risk of myocardial infarction (adjusted HR [aHR], 1.05 [95% CI, 1.01–1.10]) but not associated with increased risk of overall CVD (aHR, 1.02 [95% CI, 1.00–1.05]) or ischemic stroke (aHR, 1.02 [95% CI, 0.98–1.06]). However, when AMD was accompanied by visual disability, there was increased risk of CVD (aHR, 1.17 [95% CI, 1.06–1.29]), myocardial infarction (aHR, 1.18 [95% CI, 1.01–1.37]), and ischemic stroke (aHR, 1.20 [95% CI, 1.06–1.35]). These trends were more evident in women and subjects with cardiometabolic comorbidities. CONCLUSIONS: AMD with visual disability, but not all AMD, was associated with an increased risk of CVD. Patients with AMD who have visual disability should be targeted for CVD prevention.