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C. A. McCannel, C. Liu, CAPT Research Group; Statin Use and the Incidence of Choroidal Neovascularization and Geographic Atrophy in the Complications of Age-Related Macular Degeneration Prevention Trial (CAPT). Invest. Ophthalmol. Vis. Sci. 2007;48(13):3656.
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To evaluate the impact of statin use on the incidence of choroidal neovascularization (CNV) and geographic atrophy (GA) among patients with early age-related macular degeneration (AMD).
1052 participants with ≥10 large (>125µ) drusen and visual acuity ≥20/40 in each eye were enrolled into CAPT. Participants having their final CAPT visit after May 2005 were interviewed on their history of use of cholesterol lowering drugs, including statins. Trained readers identified CNV and endpoint GA (> 1 MPS disc area of GA) based on review of fundus photos and fluorescein angiograms taken at annual follow-up visits and when patients reported symptoms. The Cox model with statin use as a time-dependent covariate for modeling person-specific risk was used to estimate relative risk (RRs) and (95% CIs). Analyses were repeated on the subset of patients with no change in statin use during their time at risk in CAPT.
Among 744 patients providing a medication use history, 86 started statins before CAPT enrollment, 28 started in the same year as CAPT, 182 started during CAPT, and 448 never used statins. CNV developed in 176 eyes and GA developed in 80 eyes. Including statin use as a time-dependent covariate in the survival analysis yielded a RR for CNV of 1.20 (0.86-1.68). When the analysis was restricted to those with no change in statin use, the RR for CNV was 1.13 (0.69-1.88). The RR for GA was 0.62 (0.36-1.06) when statin use was included as a time-dependent covariate and was 0.41 (0.15 - 1.14) in the restricted group. Adjusting for other risk factors had little impact on the results.
There is no consensus in the literature on whether or not statins offer protection against progression of AMD. CAPT data do not support the concept of a strong protective effect of statins against the development of CNV. CAPT statin users had a lower risk of GA, but not to a statistically significant degree.
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