Bidirectional Association Between Age-Related Macular Degeneration and Cardiovascular Disease: A Population-Based Cohort Study in Taiwan with 15-Year Follow-up

PURPOSE: To investigate the bidirectional association between age-related macular degeneration (AMD) and cardiovascular disease (CVD), including acute myocardial infarction (AMI) and ischemic stroke (IS), in a large Taiwanese cohort. METHODS: We conducted a retrospective cohort study using electronic health records from China Medical University Hospital (CMUH), Taiwan. From 2003 to 2014, we identified 9,333 AMD patients with 37,332 matched controls, and 26,897 CVD patients with 107,588 matched controls. All patients were followed through December 31, 2019. Multivariable Cox regression was used to estimate the risk of CVD in AMD patients and the risk of AMD in CVD patients. The effects of common cardiovascular medications were also analyzed. RESULTS: AMD patients had an increased risk of AMI (adjusted HR = 1.45, 95% CI = 1.25-1.69) and IS (adjusted HR = 1.78, 95% CI = 1.52-2.09) compared to controls. CVD patients had a higher risk of AMD (adjusted HR = 2.57, 95% CI = 1.30-5.09). Aspirin use among CVD patients was associated with a lower risk of AMD (HR = 0.69, 95% CI = 0.50-0.94). Several comorbidities, including diabetes, hypertension, and chronic kidney disease, further increased risks in both directions. CONCLUSION: This population-based study demonstrates a significant bidirectional association between AMD and CVD in Taiwan. Integrated screening and management should be considered for patients with either condition.