Purpose:
To evaluate the association of aspirin use with advanced age-related macular degeneration (AMD)
Methods:
At baseline, the 4,203 participants enrolled in the Age-Related Eye Disease Study 2 (AREDS2) were evaluated with centrally graded fundus photographs for severity of AMD and aspirin use was assessed with a standardized questionnaire. The severity of AMD was classified with the AREDS simple scale, ranging from no large drusen in either eye to advanced AMD in one eye. This scale was expanded in the most severe end to include the participants with advanced disease in one eye and further separated into either neovascular (NV) AMD or central geographic atrophy (CGA) associated with AMD. Aspirin use was categorized as: 1. less than 5 times per week, 2.more than 5 times per week with less than 2 per day, or 3. more than 5 times per week with 2 or more per day. Univariate analyses were performed adjusting for age and sex. Multivariable regression analyses were conducted adjusting for additional risk factors including smoking, cardiovascular disease, and other medications.
Results:
4,188 AREDS2 participants who had complete data were analyzed. 2046 (48.8%) are taking aspirin at least 5 times per week and they tend to be older, male, with history of diabetes, hypertension, hypercholesterolemia, and cardiovascular disease. We grouped the participants with AREDS Simple Scale Score of 0, 1, and 2 together (n=661) as the control group. We compared those with AREDS Simple Scale Score of 3 (bilateral large drusen or pigmentary change in one eye; n=692), 4 (bilateral large drusen and bilateral pigmentary changes; n=1369), and 5 (advanced AMD in one eye with bilateral large drusen and pigmentary changes; n=1466) with the control group. 1304 had NV AMD and 162 had CGA. The multivariate model results,demonstrated the following results (see Table).
Conclusions:
The observational AREDS2 results demonstrate an inverse relationship between the various stages of AMD with aspirin use. Previous studies have demonstrated inconsistent results of this association, while randomized controlled clinical trials of aspirin found a non significant protective effect of aspirin use in any reported AMD. Future analyses of the incident AMD in AREDS2 may provide further insight into this subject.
Clinical Trial:
http://www.clinicaltrials.gov NCT00345176
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: risk factor assessment