No abstract

Genetic and epidemiologic studies have shown that lipid genes and High Density Lipoproteins (HDL) are implicated in age-related macular degeneration (AMD). We studied circulating lipid levels in relation to AMD in a large European dataset, and investigated whether this relationship is driven by certain sub fractions. Design: (Pooled) analysis of cross-sectional data. Participants: 30,953 individuals aged 50+ participating in the E3 consortium; and 1530 individuals from the Rotterdam Study with lipid sub fraction data. Methods: In E3, AMD features were graded per eye on fundus photographs using the Rotterdam Classification. Routine blood lipid measurements were available from each participant. Data on genetics, medication and confounders such as body mass index, were obtained from a common database. In a subgroup of the Rotterdam Study, lipid sub fractions were identified by the Nightingale biomarker platform. Random-intercepts mixed-effects models incorporating confounders and study site as a random-effect were used to estimate the associations. Main Outcome Measures: early, late or any AMD, phenotypic features of early AMD, lipid measurements. Results: HDL was associated with an increased risk of AMD, corrected for potential confounders (Odds Ratio (OR) 1.21 per 1mmol/L increase (95% confidence interval[CI] 1.14-1.29); while triglycerides were associated with a decreased risk (OR 0.94 per 1mmol/L increase [95%CI 0.91-0.97]). Both were associated with drusen size, higher HDL raises the odds of larger drusen while higher triglycerides decreases the odds. LDL-cholesterol only reached statistical significance in the association with early AMD (p=0.045). Regarding lipid sub fractions: the concentration of extra-large HDL particles showed the most prominent association with AMD (OR 1.24 [95%CI 1.10-1.40]). The CETP risk variant (rs17231506) for AMD was in line with increased-HDL levels (p=7.7x10-7); but LIPC risk variants (rs2043085, rs2070895) were associated in an opposite way (p=1.0x10-6 and 1.6x10-4). Conclusions: Our study suggests that HDL-cholesterol is associated with increased risk of AMD and triglycerides negatively associated. Both show the strongest association with early AMD and drusen. Extra-large HDL sub fractions seem to be drivers in the relation with AMD, variants in lipid genes play a more ambiguous role in this association. Whether systemic lipids directly influence AMD or represent lipid metabolism in the retina remains a question to be answered.

Our results suggest that moderate alcohol consumption is associated with relative financial security and good health with the exception of higher levels of anxiety amongst drinkers.

Main results-Being in rented accommodation and in a household without access to a car carried 35-45% higher mortality rate over 21 years and similar excess risk of being in an institution in 1991. Marital status and living arrangements were weaker predictors of death but being single was a major predictor of moving to an institution for men. Losing household access to a car was a strong factor for mortality for men and for institutionalisation for men aged 55-64 in 1971. The eVects were weaker for women. Moving into rented accommodation was a predictor of both outcomes for women and of death for the younger cohort of men. People who started to live alone in the inter-census period were at reduced risk of dying.Conclusions-These results demonstrate persistence of inequalities in health related outcomes throughout old age, both in those with unfavourable circumstances in mid-life and in those who, in later life, have lost earlier advantages (J Epidemiol Community Health 1999;53:765-774) The debate on socioeconomic inequalities in health has focused mainly on mortality before the age of 65 years. Less attention has been paid to older age groups, in part because of difficulties in assigning socioeconomic status to retired people, and perhaps because of assumptions that the aging process is the main determinant of health outcomes. Prospective data linking social class (based on current or previous occupation recorded at the 1971 census) and mortality up to 10 years, showed the steep class gradient persisting into old age. The results for women were not reported.1 Other descriptors of socioeconomic status, such as housing tenure, car ownership, are less prone to gender and age bias and have been shown to predict mortality in elderly people in shortterm follow up (10 years). 2A minority of people end their days in a communal establishment such as a residential or nursing home. Over the past decade institutional care for elderly people in the United Kingdom rose by around 30%, reflecting both the increasing numbers in this age group in the population 3 and increasing proportions entering institutions. 4 Little is known of the long term risk of institutional care in old age for people in middle age and early retirement.In this study we examined the association between socioeconomic and demographic factors and mortality over a period of 21 years, and looked at the relations between changes in these circumstances in the first 10 years and both subsequent mortality and institutional residence at the end of the period. Although mortality relative to changes in social class 5 6 and housing tenure 7 at working ages have been reported and changes in household circumstances among the elderly 8 have been described, the eVects of those changes on mortality and institutional residence among older people in Great Britain had not been looked at previously. Methods DATA SOURCEThe Longitudinal Study (LS) links data from successive censuses since 1971 with routinely collected vital registration data from the National Health Servic...