Abstract
Purpose :
To determine the effect of statins on choroidal neovascularization (CNV) development in patients with nonexudative age-related macular degeneration (AMD). While research on the effect of statins on AMD progression has been contradictory, few studies have specifically examined CNV development. A recent prospective study by Miller et al. found that high-dose statins may protect against CNV in high-risk AMD patients. We hypothesized decreased rates of CNV in nonexudative AMD patients on statins.
Methods :
Using the Stanford University Medical Center (SUMC) Clinical Data Warehouse, we performed a retrospective cohort analysis of patients with nonexudative AMD (identified using ICD-9/ICD-10 codes) seen at SUMC since 2008. The influence of statin exposure and covariates age, gender, race, and presence of comorbidities (ICD-9/ICD-10 codes for hypercholesterolemia, hypertension, cardiovascular disease, or cerebrovascular disease) on development of CNV (ICD-9/ICD-10) were examined using frequency calculations and unadjusted and adjusted logistic regression.
Results :
Analysis of 4,060 nonexudative AMD patients showed 50.9% on statins and 49.1% without. 73.2% of all nonexudative AMD patients developed CNV. Nonexudative AMD patients on statins were older with more comorbidities (hypercholesterolemia, hypertension, cardiovascular disease, or cerebrovascular disease) than those not on statins. Univariate logistic regression showed an association between statin use and CNV development (OR 1.37, CI 1.16-1.61) which decreased with multivariate adjustment (OR 1.27, CI 1.06-1.51). Adjusted analysis also showed CNV development associated with older age (OR 2.82, CI 2.32-3.44) and non-white race (OR 0.50, CI 0.40-0.61). Comorbid conditions (Univariate: OR 1.38, CI 1.16-1.65) were not significantly associated with CNV after multivariate adjustment (OR 1.02, CI 0.84-1.25).
Conclusions :
Many patients with nonexudative AMD go on to develop CNV. While an association has been shown between statin use and CNV development, this relationship is likely complicated by other risk factors like smoking, alcohol, BMI, lipid levels, presence of multiple comorbidities, and severity of comorbidities. Further prospective and large-cohort studies are needed to investigate the influence of statins in relation to such factors.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.