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la Santé
estimate of 1.22 per 1 standard deviation increase in
HDL-cholesterol. No causal effect of LDL-cholesterol or
triglycerides was found. Variants in the Cholesteryl Es-
ter Transfer Protein CETP gene region associated with
increased circulating HDL-cholesterol also associate
with increased AMD risk, although variants in the He-
patic lipase LIPC gene region that increase circulating
HDL-cholesterol have the opposite direction of associ-
ation with AMD risk. {3}
Arterial hypertension
In the Los Angeles Latino Eye Study, diastolic hyper-
tension is associated with a risk of developing 3-fold
exudative AMD after matching for age, gender and to-
bacco status. In addition, an increase in diastolic blood
pressure of 10mmHg doubles the risk of exudative
AMD. The study also found a significant association be-
tween diastolic blood pressure greater than or equal
to 85mmHg and confluent serous drusen, with an odds
ratio of 1.3. {4}
Cardiovascular and cerebrovascular accidents
Among patients with AMD, the cumulative 10-year in-
cidence of coronary artery disease was 30.9% (4 cases
/ 15) versus 10% (918 cases / 11,399) for those with-
out AMD. After adjusting for age, sex and ethnicity, AMD
appears to be significantly associated with the risk of
coronary heart disease, with a relative risk of 3. Never-
theless, the limited number of cases with AMD in this
study does not allow for further multivariate analysis. In
another study of 195 patients with AMD in at least one
eye, 97 patients with AMD without neovascularization
and 115 patients without serous drusen or pigmented
epithelium abnormalities between cardiovascular dis-
ease and AMD, with a relative risk of 7.53. AREDS report
13 also highlights cardiovascular excess mortality in
patients with AMD. {5}
Obesity
In a cohort of 261 patients over the age of 60 with
age-related maculopathy during an average follow-up
of 4.6 years, Seddon et al. Show that the risk of disease
progression increases with body mass index {6}
Refractive disorders
Several studies have found a significant association
between hyperopia and AMD. In the AREDS study, a
significant association appears between hyperopia and
exudative AMD, with an odds ratio of 2.31. In the ED-
CCS (Eye Disease Case-Control Study), an association
between hyperopia and exudative AMD is also estab-
lished, with an odds ratio of 1.5. The studies NHANES I,
Beaver Dam, Framingham and Rotterdam also establish
an association between hyperopia and ARM or AMD.
Exposure to UV rays
In the AREDS study, sunlight appears initially as a risk
factor for AMD, but the results are no longer significant
using a multivariate analysis model. Similarly, in the
POLA study, the relationship between exposure to UV
and AMD could not be established. {7}
Vitamin A
Various studies conducted in AMD seem to exclude vi-
tamin A as a factor of susceptibility or protective factor.
In the Blue Mountains study, a comparison of 159 cases
with 1,884 controls does not suggest a significant asso-
ciation. In the AREDS study, a comparison of vitamin A
nutrient intakes in 4,519 participants aged 60-80 years,
after adjusting for age, gender and energy intakes, does
not lead to a significant difference. {8}, {9}
Carotenoids
Lutein and zeaxanthin are the only carotenoids found
in all ocular tissues, with the exception of the cornea,
vitreous and sclera, concentrating mainly in the macu-
lar area, in Henle's fibre layer and the inner plexiform
layer. In the AREDS study, the risk of developing AMD
or ARM was inversely associated with dietary intake of
lutein and zeaxanthin. {10}
Polyunsaturated fatty acids Omega-3
A meta-analysis by Chong and al. summarizes the re-
sults of major studies published on this topic, includ-
ing 3 prospective studies, 3 case-control studies and
3 cross-sectional studies . In 4 studies, omega-3 con-
sumption is associated with a lower risk of severe AMD,
with an odds ratio of 0.62. In 6 studies, fish consump-
tion was associated with a lower risk of ARM and severe
AMD, with an odds ratio of 0.76 and 0.67, respectively.
It should be emphasized that the results of these nu-
merous studies are extremely concordant, demonstrat-
ing a protective effect of the consumption of fatty fish
or of omega-3 fatty acids. {11}
Monounsaturated fatty acids, saturated fatty acids and
cholesterol
In addition to the concluded protective effect of ome-
ga-3 in exudative AMD, the AREDS report No. 22 shows
that high dietary intakes of monounsaturated fatty
acids, saturated fatty acids and cholesterol are signifi-
cantly associated with a risk of exudative AMD with re-
spective odds ratios of 1.80, 1.56 and 1.16 respectively.
{12}
Antioxidants and zinc
At the observational level, studies show a protective
effect of vitamin E and zinc in AMD or a dissociative
effect that can be protective for zinc and at risk for vi-
tamin E. In a French study, a protective effect was also
found on vitamin E. {13}, {14}
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