Regular Aspirin Use Linked to Greater Risk of
Blinding Age-Related Macular Degeneration
‘Findings are, at best, hypothesis-generating that
should await validation in prospective randomized studies before guiding
clinical practice or patient behavior” – invited Commentary
Jan. 21, 2013 – Regular aspirin use appears to be
associated with an increased risk of neovascular (wet) age-related
macular degeneration (AMD), which is a leading cause of blindness in
older people, and it appears to be independent of a history of
cardiovascular disease and smoking, according to a report published
Online First by JAMA Internal Medicine, a JAMA Network publication.
Aspirin is one of the most widely used medications
in the world and is commonly used in the prevention of cardiovascular
disease, such as myocardial infarction (heart attack) and ischemic
stroke. While a recent study suggested that regular aspirin use was
associated with AMD, particularly the more visually devastating
neovascular (wet) form, other studies have reported inconsistent
findings. Smoking is also a preventable risk factor for AMD, the authors
write in the study background.
Gerald Liew, Ph.D., of the University of Sydney,
Australia, and colleagues examined whether regular aspirin use (defined
as once or more per week in the past year) was associated with a higher
risk of developing AMD by conducting a prospective analysis of data from
an Australian study that included four examinations during a 15-year
period. Of 2,389 participants, 257 individuals (10.8 percent) were
regular aspirin users.
After the 15-year follow-up, 63 individuals (24.5
percent) developed incident neovascular AMD, according to the results.
“The cumulative incidence of neovascular AMD among
non-regular aspirin users was 0.8 percent at five years, 1.6 percent at
10 years, and 3.7 percent at 15 years; among regular aspirin users, the
cumulative incidence was 1.9 percent at five years, 7 percent at 10
years and 9.3 percent at 15 years, respectively,” the authors note.
“Regular aspirin use was significantly associated with an increased
incidence of neovascular AMD.”
The authors note that any decision concerning
whether to stop aspirin therapy is “complex and needs to be
individualized.”
“Currently, there is insufficient evidence to
recommend changing clinical practice, except perhaps in patients with
strong risk factors for neovascular AMD (e.g., existing late AMD in the
fellow eye) in whom it may be appropriate to raise the potentially small
risk of incident neovascular AMD with long-term aspirin therapy,” the
authors conclude.
(JAMA Intern Med. Published online January 21,
2013. doi:10.1001/jamainternmed.2013.1583. Available pre-embargo to the
media at
http://media.jamanetwork.com.)
Editor’s Note: This study was supported by project
grants from the National Health & Medical Research Council Australia.
Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures,
funding andsupport, etc.
Commentary: Relationship of Aspirin Use with
Age-Related Macular Degeneration
In an invited commentary, Sanjay Kaul, M.D., and
George A. Diamond, M.D., of Cedars-Sinai Medical Center, Los Angeles,
write: “This study has important strengths and limitations. It provides
evidence from the largest prospective cohort with more than five years
of longitudinal evaluation reported to date using objective and
standardized ascertainment of AMD.”
“The key limitation is the nonrandomized design of
the study with its potential for residual (unmeasured or unobserved)
confounding that cannot be mitigated by multivariate logistic regression
or propensity score analysis,” the authors continue.
“From a purely science-of-medicine perspective, the
strength of evidence is not sufficiently robust to be clinically
directive. These findings are, at best, hypothesis-generating that
should await validation in prospective randomized studies before guiding
clinical practice or patient behavior,” the authors conclude.
“However, from an art-of-medicine perspective,
based on the limited amount of available evidence, there are some
courses of action available to the thoughtful clinician. In the absence
of definitive evidence regarding whether limiting aspirin exposure
mitigates AMD risk, one obvious course of action is to maintain the
status quo.”
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Jan. 21, 2013 – Regular aspirin use appears to be
associated with an increased risk of neovascular (wet) age-related
macular degeneration (AMD), which is a leading cause of blindness in
older people, and it appears to be independent of a history of
cardiovascular disease and smoking, according to a report published
Online First by JAMA Internal Medicine, a JAMA Network publication.