Statin Use and the Incidence of Advanced Age-related Macular Degeneration in the Complications of Age-related Macular Degeneration Prevention Trial
Presented in part at: the Association for Research in Vision and Ophthalmology Meeting, April, 2004, Fort Lauderdale, Florida; the Macula Society Meeting, February, 2005, Key Biscayne, Florida; and the Ocular Epidemiology Symposium, January, 2007, Fort Lauderdale, Florida.
Received 9 March 2009; received in revised form 20 May 2009; accepted 23 June 2009. published online 22 October 2009.
Objective
To evaluate the impact of statin use on the incidence of advanced age-related macular degeneration (AMD) and its components, choroidal neovascularization (CNV) and geographic atrophy (GA), among patients with bilateral large drusen.
Design
Cohort study within a multicenter, randomized, clinical trial.
Participants
Patients enrolled in the Complications of Age-related Macular Degeneration Prevention Trial (CAPT).
Methods
Eligibility criteria for the clinical trial required that participants have ≥10 large (>125 μm) drusen and visual acuity ≥20/40 in each eye. Patients scheduled for their final CAPT visit after May 2005 were interviewed on their history of use of cholesterol-lowering medications, including statins. Trained readers identified CNV and end point GA (>1 Macular Photocoagulation Study disc area of GA) based on review of fluorescein angiograms and fundus photographs taken at annual follow-up visits and when patients reported symptoms. The risk ratio for participants developing CNV or developing GA associated with statin use was estimated with time-dependent Cox proportional hazards models.
Main Outcome Measures
Development of advanced AMD, CNV, and end point GA.
Results
Among 764 patients eligible for the interview, 744 (97.4%) patients completed the interview on medication use. Statin use was reported by 296 (39.8%) of those interviewed, with the majority, 187 (63.2%) of the 296, beginning use after enrollment in CAPT. Among 744 patients, advanced AMD developed in 332 (22.5%) eyes of 242 (32.5%) patients, CNV in 222 (15%) eyes of 176 (23.7%) patients, and GA in 114 (7.7%) eyes of 80 (10.8%) patients. With adjustment for other risk factors, the estimated risk ratio for eyes (95% confidence interval) associated with statin use was 1.15 (0.87–1.52) for advanced AMD, 1.35 (0.99–1.83) for CNV, and 0.80 (0.46–1.39) for GA.
Conclusions
The CAPT data are not consistent with a strong protective effect (risk ratio, ≤0.85) of statins on the development of advanced AMD among patients with bilateral large drusen.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
1Department of Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
Correspondence: CAPT Coordinating Center, University of Pennsylvania, 3535 Market Street, Suite 700, Philadelphia, PA 19104-3309
Available online: October 21, 2009.
Manuscript no. 2009-335.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Supported by grants EY012211, EY012261, and EY012279, from the National Eye Institute, National Institutes of Health, Department of Health and Human Services, an unrestricted grant from Research to Prevent Blindness and a grant from the Mayo Foundation.
A listing of the Complications of Age-related Macular Degeneration Prevention Trial (CAPT) Research Group appeared in Complications of Age-related Macular Degeneration Prevention Trial Research Group. Laser treatment in patients with bilateral large drusen: The Complications of Age-related Macular Degeneration Prevention Trial (CAPT). Ophthalmology 2006;113:1974–86.
ABSTRACT