Correlation Identified Between Aortic Stenosis and Macular Disease Risk

A recent retrospective cohort study conducted in Taiwan revealed a correlative relationship between aortic stenosis (AS) occupancy and a higher risk of macular disease.

AS is a reliable biomarker for a variety of diseases; notably, it triggers substantial inflammation of blood vessels, which is in turn one of the primary symptoms of several common macular diseases. Inflammation can introduce choroidal neovascularization and geographic atrophy, thereby exacerbating the incidence of age-related macular degeneration (AMD) and similar diseases.2

“AS may indeed influence the risk of developing macular disease, which needs a survey,” wrote Chia-Yi Lee, MD, Institute of Medicine, Chung Shan Medical University, and colleagues. “Therefore, in this study, [we] aimed to investigate and analyze the relationship between AS and each outlined macular disease.”1

Investigators sourced data from TriNetX, excluding potential participants <20 or >80 years of age, as well as those with an ocular disease diagnosed or ocular surgery performed before the beginning of the study. Additionally, an echocardiogram, electrocardiogram, cardiac catheterization, chest X-ray, or cardiac computerized tomography had to have been performed on each participant before AS diagnosis. Then each participant with AS was matched to one without, based on the propensity score-matching method. The full tally eventually came out to 421,860 participants with AS and 421,860 without.1

The study’s major outcomes included the development of AMD, retinal vascular occlusion (RVO), epiretinal membrane (ERM), and central serous chorioretinopathy (CSC). Development of each ocular disease was regarded through the ICD-10 CM codes, the arrangement of fundoscope exam, optical coherence tomography, or fluorescein angiography as indicated by procedure.1

By the end of the study, investigators noted 4426 and 3013 AMD events, 7315 and 4752 RVO events, 2780 and 1910 ERM events, and 113 and 64 CSC events in the group with AS and the group without, respectively.1

Li and colleagues indicated that the AS group displayed substantially higher incidence of all four macular diseases, with the adjusted hazard ratios (aHR) listed below:

• AMD (aHR, 1.365; 95% CI, 1.303-1.429, P <.001)
• RVO (aHR, 1.437; 95% CI, 1.385-1.490, P <.001)
• ERM (aHR, 1.348; 95% CI, 1.272-1.429, P <.001)
• CSC (aHR, 1.637; 95% CI, 1.205-2.224, P <.001)1

Subsequent log-rank testing showed a higher cumulative probability of all 4 diseases in the AS group than the non-AS group (all P <.05). Incidence of each disease was also positively correlated with a longer AS progression. Lee and colleagues also noted, however, that RVO and ERM risks were higher in the AS group than the non-AS group except for participants aged 20-44 years.1

AS is increasingly common globally; in people ≥75 years of age in the US, it exhibits an incidence of over 3%. Aortic valve replacement has proven effective in treatment but can be prohibitively expensive. Similarly, macular diseases examined in the study have substantial incidence rates globally and can have debilitating effects to visual acuity.1

While the study does indicate a connection between the 2 diseases, a causal relationship has not been confirmed. AS occupancy is related to a higher risk of macular disease, which is in turn positively correlated to AS disease time. However, Lee and colleagues indicate that more research is necessary to determine a causal relationship.1

“Because both AS and macular diseases affect the majority of the population and can lead to severe impairment and high medical costs, any relationship between the two diseases should be represented,” wrote Lee and colleagues.1

References

1. Lee CY, Yang SF, Mai EL, Huang JY, Yeh CB, Chang CK. The Relationship Between Aortic Stenosis and the Possibility of Subsequent Macular Diseases: A Nationwide Database Study. Diagnostics (Basel). 2025;15(6):760. Published 2025 Mar 18. doi:10.3390/diagnostics15060760

2. Tan W, Zou J, Yoshida S, Jiang B, Zhou Y. The role of inflammation in age-related macular degeneration. International Journal of Biological Sciences. 2020;16(15):2989-3001. doi:10.7150/ijbs.49890