Effect of Statins on the Age of Onset of Age-Related Macular Degeneration

Abstract

Purpose : This study evaluated the relationship between statin use and the age of onset of age-related macular degeneration (AMD). Additional covariates such as sex, ethnicity, smoking history, fluoxetine use, obesity, diabetes mellitus (type 1 and type 2), and hypertension were included in the regression model.

Methods : Electronic Health Records (EHR) from 52,840 patients evaluated in the University of California Los Angeles (UCLA) Ophthalmology Clinics between 2014 and 2020 were screened. Subjects with a diagnosis of AMD were included in this study, and their records were reviewed for previously described AMD risk factors: sex, ethnicity, smoking, statins, fluoxetine, obesity, diabetes mellitus, and hypertension. Survival analysis was performed using a Cox proportional hazards regression model and visualized using Kaplan Meier survival curves.

Results : 5,498 of 52,840 patients included in the study (10.4%) were diagnosed with AMD. Statin use appeared to be associated with a later onset of AMD (HR=0.8822, p=0.0006), delaying the age of onset of AMD. However, female sex (HR=1.1382, p=00002), obesity (HR=1.4227, p<0.0001), and usage of fluoxetine (HR=1.3508, p=0.0032) were associated with an earlier onset of AMD. In addition to these factors, when adding ethnicity as a covariate to the model, non-hispanic black ethnicity (HR=0.5687, p<0.0001) and hispanic ethnicity (HR=0.8269, p=0.0028) appeared to be associated with a later onset of AMD. When stratifying for ethnicity, statin use, female sex, obesity, and fluoxetine use were four covariates that appeared to be significant only within the non-hispanic white subjects.

Conclusions : Statin use is associated with a delay in the onset of AMD, particularly in non-hispanic white subjects. Females, obesity, and fluoxetine are associated with an earlier onset of AMD, whereas non-hispanic black and hispanic ethnicities appear to be associated with a later onset of AMD.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Figure 1: Kaplan Meier survival curves of age of onset of AMD, stratified by statin status. Among patients with AMD, 2,527 patients were on statins and 2,971 patients had no history of statin use. Confidence intervals are displayed as the shaded region around each curve.

 

Table 1: Cox proportional hazards model for the association of risk factors, statin use history, and ethnicity with the rate of onset of AMD, stratified by ethnic group. Significant covariates are marked with an asterisk, accounting for Bonferroni correction.