The Association of Aspirin Use With Age-Related Macular Degeneration

Study Questions:

What is the effect of regular aspirin use on the risk for developing age-related macular degeneration (AMD)?

Methods:

A prospective analysis was conducted of data from an Australian population-based cohort with four examinations during a 15-year period (1992-1994 to 2007-2009). Participants completed a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. AMD was graded side-by-side from retinal photographs taken at each study visit to assess the incidence of neovascular (wet) AMD and geographic atrophy (dry AMD) according to the international AMD classification.

Results:

Of 2,389 baseline participants with follow-up data available, 257 individuals (10.8%) were regular aspirin users and 63 of the 2,389 developed neovascular AMD. Persons who were regular aspirin users were more likely to have incident neovascular AMD: the 15-year cumulative incidence was 9.3% in users and 3.7% in nonusers. After adjustment for age, sex, smoking, history of cardiovascular disease, systolic blood pressure, and body mass index, persons who were regular aspirin users had a higher risk of developing neovascular AMD (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.25-4.83). The association showed a dose-response effect (multivariate-adjusted p = 0.01 for trend). Aspirin use was not associated with the incidence of geographic atrophy (multivariate-adjusted OR, 0.99; 95% CI, 0.59-1.65).

Conclusions:

The authors concluded that regular aspirin use is associated with increased risk of incident neovascular AMD, independent of a history of cardiovascular disease and smoking.

Perspective:

This study found that regular aspirin use was associated with increased risk of neovascular AMD during a 15-year follow-up period, independent of history of cardiovascular disease, smoking, and other potential AMD risk factors. These results confirm the findings from the European cross-sectional survey that reported a twofold increased prevalence of neovascular AMD among regular aspirin users. This potential risk, however, appears small (9.3% after 15 years), and should be balanced with the significant morbidity and mortality of suboptimally treated cardiovascular disease; any decision concerning aspirin therapy needs to be individualized, taking into account overall risk/benefit.

Clinical Topics: Prevention, Smoking

Keywords: Odds Ratio, Follow-Up Studies, Morbidity, Cross-Sectional Studies, Blood Pressure, Smoking, Prevalence, Body Mass Index, Geographic Atrophy, Australia, Cardiovascular Diseases, Macular Degeneration, Confidence Intervals, Neovascularization, Pathologic


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