Patients with AMD have a higher prevalence of VHD and are more likely to undergo a heart valve–related procedure compared to patients without AMD, with no difference between patients with SDDs and patients without SDDs. Photo: Cleveland Clinic. Click image to enlarge.

Recent studies have reported an association between valvular heart disease (VHD) and the presence of subretinal drusenoid deposits (SDDs), a distinct manifestation of age-related macular degeneration (AMD). These findings, however, were based on self-reported questionnaires and relatively modest cohort sizes. In a new study, researchers investigated the putative associations between AMD and VHD and the influence  of SDDs on the cardiac condition. They found that a higher percentage of patients with AMD undergo a heart valve procedure compared to patients without AMD. Moreover, the presence of a valvular condition may indicate a predisposition to developing AMD. The team’s paper on the work was recently published in Ophthalmology Science.

A total of 9,220 patients were included, 945 with AMD and 8,275 control without the condition. Among the patients with AMD, 547 had drusen and SDDs, and 398 had drusen only.

The findings indicate that a higher percentage of patients with AMD were diagnosed with a major VHD such as aortic stenosis (4.05%), aortic regurgitation (2.24%) or mitral regurgitation (6.18%) compared to unaffected controls. Moreover, heart valve procedures were also more prevalent among AMD patients than controls, including aortic valve replacement and tricuspid valve replacement.

In regards to the connection of SDDs and VHD, valvular defects can vary widely, and not all defects are diagnosed at early stages or require valve replacement; therefore, a higher prevalence of VHD may still exist among patients with SDDs who do not undergo a valve-related procedure, the authors noted.

The team’s paper notes that, despite sharing common risk factors such as age, smoking, hypertension, type 2 diabetes, high body mass index, dyslipidemia and a history of cardiovascular disease, no clear association has been established between AMD and VHD. Studies have suggested that atherosclerosis contributes to the pathogenesis of both VHD and AMD and that activation of the complement pathway has been reported in subjects with the finding, the authors did point out, however.

They developed a supervised machine learning model that can predict if an individual has AMD based on the patient’s history of VHD, suggesting that a patient’s valvular status is at least partly indicative of the patient’s risk of developing AMD. 

Lastly, the authors suggest that patients recently diagnosed with AMD should undergo an assessment of their valvular health, as identifying AMD as a biomarker for predicting VHD could be highly beneficial.

“These findings may suggest the importance of cross-referral between eyecare providers and cardiologists for patients who present with any form of VHD or AMD,” the authors concluded in their paper. “The findings also may suggest the potential existence of a common pathogenic pathways for AMD and VHD. Identifying this factor may help to identify novel therapeutic targets for these conditions.”