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Original Investigation |

The Association of Aspirin Use With Age-Related Macular Degeneration

Gerald Liew, PhD; Paul Mitchell, PhD; Tien Yin Wong, PhD; Elena Rochtchina, MAppStat; Jie Jin Wang, PhD
JAMA Intern Med. 2013;173(4):258-264. doi:10.1001/jamainternmed.2013.1583.
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Objective  To determine whether regular aspirin use is associated with a higher risk for developing age-related macular degeneration (AMD) by using analyzed data from a 15-year prospective cohort.

Methods  A prospective analysis was conducted of data from an Australian population-based cohort with 4 examinations during a 15-year period (1992-1994 to 2007-2009). Participants completed a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. Age-related macular degeneration was graded side-by-side from retinal photographs taken at each study visit to assess the incidence of neovascular (wet) AMD and geographic atrophy (dry AMD) according to the international AMD classification.

Results  Of 2389 baseline participants with follow-up data available, 257 individuals (10.8%) were regular aspirin users and 63 of the 2389 developed neovascular AMD. Persons who were regular aspirin users were more likely to have incident neovascular AMD: the 15-year cumulative incidence was 9.3% in users and 3.7% in nonusers. After adjustment for age, sex, smoking, history of cardiovascular disease, systolic blood pressure, and body mass index, persons who were regular aspirin users had a higher risk of developing neovascular AMD (odds ratio [OR], 2.46; 95% CI, 1.25-4.83). The association showed a dose-response effect (multivariate-adjusted P = .01 for trend). Aspirin use was not associated with the incidence of geographic atrophy (multivariate-adjusted OR, 0.99; 95% CI, 0.59-1.65).

Conclusion  Regular aspirin use is associated with increased risk of incident neovascular AMD, independent of a history of cardiovascular disease and smoking.

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Figure 1. Flowchart of the Blue Mountains Eye Study (BMES) participants during 15 years of follow-up.

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Figure 2. Left eye retinal photograph of a participant with regular aspirin use who developed neovascular age-related macular degeneration with an extensive subretinal fibrous scar.

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Figure 3. Cumulative incidence of neovascular age-related macular degeneration by time intervals. Cumulative incidence was estimated using the Kaplan-Meier (product limit) method.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Submit a Comment
This study does not answer the most important question
Posted on March 15, 2013
David Louis Keller, M.D.
Providence Medical Group
Conflict of Interest: None Declared
This study did not quantify the actual milligram dose of aspirin which was taken by the subjects. The authors only state that aspirin is usually prescribed at a dose of 150 mg per day in Australia, which is an odd dose in that it too small for effective analgesia and at least double the dose required for steady-state inhibition of platelet aggregation to reduce cardiovascular thrombosis. The "dose-response effect" which the authors found refers to the "time dose" or cumulative amount of time the patient took aspirin (at any milligram dose). Most aspirin users in the USA take the lowest dose available (81 mg here) for the purpose of platelet inhibition, not analgesia. The physicians who treat these patients need to know whether an aspirin dose of 81 mg per day increases the risk of age-related macular degeneration, not a dose of 150 mg or higher, which is less commonly prescribed here.
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