When links between age-related macular degeneration (AMD) and cardiovascular disease are discussed, the conversation is usually centered around statins; scrutiny of aspirin is less prominent. Yet, barring contraindications, almost every patient receiving treatment for cardiovascular disease gets a daily (low) dose of aspirin – it’s estimated that 40,000 tons of the drug are consumed each year. Consequently, many patients with AMD also receive aspirin, begging the question of whether aspirin causes AMD.
The data to date have been inconclusive. Randomized trial data suggests that aspirin protects against the development of AMD (1,2) while observational studies have suggested that aspirin use raises (3), reduces (4) or has no impact (5) on AMD progression. Now Emily Chew has stepped in. Chew is the Deputy Director of Division of Epidemiology and Clinical Applications at the National Eye Institute in Bethesda, MD, USA, and the Chair of the Age-Related Eye Disease Study 2 (AREDS 2) study. A large multi-center randomized trial involving approximately four thousand patients, AREDS2 was designed to determine whether certain dietary supplements could help treat AMD and cataracts. Helpfully, analysis of the associated demographic data collected from the trial also generated insight into the impact of aspirin on AMD. Chew presented the results of the investigation at the recent Angiogenesis, Exudation, and Degeneration 2014 meeting (6). It compared just over 1,900 aspirin users with matched control non-aspirin users, and examined the propensity of each group to develop AMD. No link between aspirin use and the development of AMD was found. Thus, patients receiving chronic aspirin therapy shouldn’t feel unduly worried about developing AMD; the evidence suggests that they’re not at increased risk.
References
- W.G. Christen et al., “Low-dose aspirin and medical record-confirmed age-related macular degeneration in a randomized trial of women”, Ophthalmology, 116, 2386–2392 (2009). W.G. Christen et al., “Age-related maculopathy in a randomized trial of low-dose aspirin among US physicians”, Arch. Ophthalmol., 119, 1143–1149 (2001). G. Liew et al., “The association of aspirin use with age-related macular degeneration”, JAMA Intern Med., 173, 258–264 (2001). H.L. Wilson et al., “Statin and aspirin therapy are associated with decreased rates of choroidal neovascularization among patients with age-related macular degeneration”, Am. J. Ophthalmol., 137, 615–624 (2004). R. van Leeuwen et al., “Is medication use associated with the incidence of early age-related maculopathy? Pooled findings from 3 continents”, Ophthalmology, 111, 1169–1175 (2004). E.Y. Chew, “AREDS2 Update”, Oral Presentation at the Angiogenesis, Exudation, and Degeneration 2014 meeting, February 8th 2014, Miami, Florida.
