Statin use and the incidence of advanced age-related macular degeneration in the Complications of Age-related Macular Degeneration Prevention Trial.
OBJECTIVE
To evaluate the impact of statin use on the incidence of advanced age-related macular degeneration (AMD) and its components, choroidal neovascularization (CNV) and geographic atrophy (GA), among patients with bilateral large drusen.


METHODS
Cohort study within a multicenter, randomized, clinical trial.


METHODS
Patients enrolled in the Complications of Age-related Macular Degeneration Prevention Trial (CAPT).


METHODS
Eligibility criteria for the clinical trial required that participants have >or=10 large (>125 microm) drusen and visual acuity >or=20/40 in each eye. Patients scheduled for their final CAPT visit after May 2005 were interviewed on their history of use of cholesterol-lowering medications, including statins. Trained readers identified CNV and end point GA (>1 Macular Photocoagulation Study disc area of GA) based on review of fluorescein angiograms and fundus photographs taken at annual follow-up visits and when patients reported symptoms. The risk ratio for participants developing CNV or developing GA associated with statin use was estimated with time-dependent Cox proportional hazards models.


METHODS
Development of advanced AMD, CNV, and end point GA.


RESULTS
Among 764 patients eligible for the interview, 744 (97.4%) patients completed the interview on medication use. Statin use was reported by 296 (39.8%) of those interviewed, with the majority, 187 (63.2%) of the 296, beginning use after enrollment in CAPT. Among 744 patients, advanced AMD developed in 332 (22.5%) eyes of 242 (32.5%) patients, CNV in 222 (15%) eyes of 176 (23.7%) patients, and GA in 114 (7.7%) eyes of 80 (10.8%) patients. With adjustment for other risk factors, the estimated risk ratio for eyes (95% confidence interval) associated with statin use was 1.15 (0.87-1.52) for advanced AMD, 1.35 (0.99-1.83) for CNV, and 0.80 (0.46-1.39) for GA.


CONCLUSIONS
The CAPT data are not consistent with a strong protective effect (risk ratio, <or=0.85) of statins on the development of advanced AMD among patients with bilateral large drusen.
Maguire
Maureen G
MG
Department of Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-3309, USA. maguirem@mail.med.upenn.edu
Ying
Gui-shuang
GS
McCannel
Colin A
CA
Liu
Chengcheng
C
Dai
Yang
Y
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003327:Coronary Disease / Q000517:prevention & control; D004363:Drug Utilization; D005260:Female; D005451:Fluorescein Angiography; D057092:Geographic Atrophy / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008268:Macular Degeneration / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D014792:Visual Acuity
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors