Maintaining Good Cardiovascular Health Can Reduce AMD

To help maintain overall cardiovascular health as early as possible to reduce the incidence of AMD, ophthalmologists should consider collaborating with cardiologists and incorporating cardiovascular health assessments such as blood pressure, lipids and glucose screening into AMD risk evaluations. Photo: Getty Images. Prior research has established associations between cardiovascular health, certain healthy lifestyle factors and age-related macular degeneration (AMD), but the Life’s Essential 8 score—a relatively new tool for evaluating cardiovascular status—represents a broader and more integrated evaluation. Introduced by the American Heart Association in 2022, the Life’s Essential 8 score combines eight key metrics into a single holistic framework: diet, nicotine exposure, sleep duration, physical activity, body mass index, blood glucose, blood lipids and blood pressure. Proponents say this focus on the interplay of lifestyle and metabolic factors provides a more reliable prediction of AMD risk; however, a thorough assessment of the relationship between ideal cardiovascular health indicators and AMD risk has not been conducted.In a recent study, Chinese researchers explored this relationship, including the role of genetics, and found that maintaining good cardiovascular health can reduce AMD incidence regardless of genetic background. The findings were reported recently in Investigative Ophthalmology & Visual Science.This prospective cohort study included 268,634 UK Biobank participants with high, moderate or low cardiovascular health status based on Life’s Essential 8 scores. No significant interaction was found between Life’s Essential 8 scores and one’s polygenic risk score  in relation to AMD risk, suggesting that the relationship remains consistent irrespective of genetic risk factors. There was also an inverse relationship between the Life’s Essential 8 score and AMD risk, consistent across subgroups and sensitivity analyses.“This aligns with existing evidence suggesting that maintaining healthy behaviors—such as quitting smoking, abstaining from alcohol, maintaining a healthy body mass index and controlling blood glucose levels and blood pressure—play a crucial role in reducing the risk of retinal aging and AMD,” the authors wrote in their IOVS paper.It's been shown that obesity, sleep deprivation, dyslipidemia and glucose metabolism disorders are linked to increased inflammation, which contributes to early AMD pathogenesis. Additionally, smoking, physical inactivity and elevated blood pressure can influence oxidative stress and retinal damage, which are key contributors to AMD development. “These interconnected mechanisms likely interact to exacerbate AMD progression, highlighting the importance of overall cardiovascular health in mitigating the risk of AMD,” the authors explained in their article.Individuals under 60 years of age showed a stronger beneficial association than those 60 and older, indicating that adopting good cardiovascular practices earlier can better reduce the incidence of AMD.Subgroup analyses also showed a stronger beneficial association in women and nondrinkers. Regarding women, this could be attributed to several factors, including estrogen.“Estrogen, with its antioxidant and anti-inflammatory properties, may enhance the benefits of cardiovascular health in women, making them more responsive to higher Life’s Essential 8 scores,” the researchers  wrote. “Post-menopause women experience higher AMD prevalence, and the influence of cardiovascular health becomes more apparent. Women also tend to have a higher prevalence of chronic inflammation than men, and this contributes to AMD progression.” All of these highlight the need for gender-specific approaches to cardiovascular health interventions to reduce AMD risk, the authors noted.An association was found between higher LDL and triglyceride concentrations and reduced AMD risk, showing these lipids “may play a protective role, potentially by supporting retinal health through lipid metabolism and membrane formation,” the authors explained. However, potential confounders and reverse causality should be considered, as early-stage AMD may alter lipid profiles, they continued. This suggests that further investigation is needed in the relationship between LDL, triglycerides and AMD to uncover the exact mechanisms.In addition to lifestyle modifications such as physical activity, a balanced diet and smoking cessation to help reduce the risk of AMD, ophthalmologists can incorporate cardiovascular health assessments, such as blood pressure, lipids and glucose screening into AMD risk evaluations or collaborate with cardiologists for comprehensive care. The authors suggest future research should explore the feasibility of Life’s Essential 8 score-based interventions in AMD management. Click here for the journal source.  Wang W, Ren R, Liu Y, et al. Life’s essential 8, genetic susceptibility and the risk of age-related macular degeneration: a prospective cohort study. Invest Ophthalmol Vis Sci. 2025;66:54.