title: Age-related macular degeneration and risk of total and cause-specific mortality over 15 years.
abstract: OBJECTIVE
  We aimed to investigate the independent association between AMD and risk of ischemic heart disease (IHD), stroke, and cardiovascular (CVD) mortality, and all-cause mortality over 15 years.
  
  
  METHODS
  3654 participants aged 49+ years at baseline were followed over 15 years. AMD was assessed from retinal photographs. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using Cox models.
  
  
  RESULTS
  71.4% (n=162) and 34.6% (n=1037) of participants with any AMD and no AMD, respectively, died over 15 years. After multivariable-adjustment, no significant associations were observed between AMD and total- and cause-specific mortality in the overall cohort. However, among men, late AMD at baseline was associated with an increased risk of all-cause mortality (n=22; 95.7%), 15 years later: multivariable-adjusted HR, 1.80 (95% CI 1.04-3.11). Women with late AMD had 2-fold increased risk of stroke mortality (n=15; 28.9%), HR 2.10 (95% CI 1.08-4.06). Early-stage AMD was not associated with mortality risk.
  
  
  CONCLUSIONS
  Late AMD independently predicted all-cause mortality in men and stroke mortality in women, over 15 years. Although underlying mechanisms are unclear, these findings indicate that late AMD is a marker of biological aging.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia. Electronic address: bamini.gopinath@sydney.edu.au.
authors.forename: Bamini
authors.initials: B
authors.lastname: Gopinath
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia.
authors.forename: Gerald
authors.initials: G
authors.lastname: Liew
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008268:Macular Degeneration / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000401:mortality*
keywords: Age-related macular degeneration; Blue Mountains Eye Study; Cardiovascular disease; Ischemic heart disease; Mortality