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ROLE OF STATINS IN THE DEVELOPMENT AND PROGRESSION OF AGE-RELATED MACULAR DEGENERATION

VanderBeek, Brian L. MD, MPH*; Zacks, David N. MD, PhD*; Talwar, Nidhi MS*; Nan, Bin PhD; Stein, Joshua D. MD, MS*

doi: 10.1097/IAE.0b013e318276e0cf
Original Study

Purpose: To determine if statins are associated with the development or progression of age-related macular degeneration (AMD).

Methods: A large, national insurance claims database was reviewed to identify individuals aged 60 years or older who were enrolled for ≥2 years and had ≥1 visits to an eye provider. Prescription claims for statins within a 24-month look-back period and outpatient lipid laboratory values were also reviewed. Cox regression analysis was used to determine whether statin use was associated with the development of nonexudative or exudative AMD or progressing from nonexudative to exudative AMD.

Results: Of the 107,007 beneficiaries eligible for the nonexudative AMD analysis, 4,647 incident cases of nonexudative AMD occurred. Seven hundred and ninety-two incident cases of exudative AMD were found among the 113,111 beneficiaries eligible for the exudative AMD analysis. Of the 10,743 beneficiaries with known nonexudative AMD eligible for the progression model, 404 progressed to exudative AMD during their time in the plan. After multivariable analysis, statin use was not associated with the development of nonexudative AMD (P > 0.05). Statin use of >12 months was associated with an increased hazard for developing exudative AMD (P < 0.005). Among those taking statins, only enrollees with the highest lipid levels had an increased hazard of developing exudative AMD (P < 0.05).

Conclusion: In those with elevated lipid levels, >1 year of statin use was associated with an increased hazard for exudative AMD. Lipid status influences the relationship between statins and the risk of AMD. Because of a number of limitations in study design, these observations warrant further study and should not be the rationale for any changes in the use of statins to treat dyslipidemias.

Supplemental Digital Content is Available in the Text.Compared with enrollees who were prescribed statins for <6 months, those prescribed statins for >1 year had a higher hazard of developing exudative age-related macular degeneration (AMD) but not nonexudative AMD. The subgroup of patients with persistently high lipid levels, despite statin use, has the highest hazard for development or progression to exudative AMD.

*Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan

Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.

Reprint requests: Brian L. VanderBeek, MD, MPH, University of Michigan, Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105; e-mail: blbeek@med.umich.edu

Supported by National Eye Institute K23 Mentored Clinician Scientist Award (JDS; EY019511), Blue Cross Blue Shield of Michigan Foundation (JDS), University of Michigan Anthony Adamis Research Award (JDS).

Presented in part at the 2010 Retina Society meeting in San Francisco, CA, September 23, 2010.

The authors have no proprietary interest in any material discussed in this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com).

© The Ophthalmic Communications Society, Inc.