Author: Marko Popovic (Canada)
Co-authors: Arshia Eshtiaghi, Amirthan Sothivannan, Rajeev Muni, Peter Kertes
Purpose
Age-related macular degeneration (AMD) shares many of the same risk factors with atherosclerosis. As such, there is a postulated role for lipid-lowering agents in preventing AMD. This meta-analysis investigates the possible role for statins in the prevention of AMD onset and progression.
Setting/Venue
Meta-analysis.
Methods
MEDLINE, EMBASE, Cochrane CENTRAL, and the reference lists of included studies were systematically searched from inception to September 2020. Studies were included if they measured the risk of AMD development or progression with statin use. Two reviewers independently assessed study eligibility and risk of bias. The primary outcomes assessed were AMD incidence and progression. Secondary outcomes were the incidence of early AMD, late AMD, choroidal neovascularization, and geographic atrophy. Meta-analysis was conducted in R using a random effects model with a Paule-Mandel estimator, with pooled risk ratios and 95% confidence intervals reported for all outcomes. A p-value of 0.05 was considered statistically significant for all analyses.
Results
Twenty-one articles (1 randomized controlled trial, 20 observational studies) collectively reporting on 1,460,989 participants were included. The mean age was 67, 54.8% of participants were Caucasian, and 53.2% were female. The pooled risk ratios [95% CI] for statin use on any, early and late AMD incidence were 1.05 [0.85, 1.29] (p = 0.44), 0.99 [0.88, 1.11] (p = 0.86), and 1.15 [0.90, 1.47] (p = 0.27), respectively. In patients with existing AMD, the respective risk ratios for statin use on incidence of AMD progression, choroidal neovascularization, and geographic atrophy were 1.04 [0.70, 1.53] (p = 0.85), 0.99 [0.66, 1.48] (p = 0.95), and 0.84 [0.58, 1.22] (p = 0.36). Subgroup analysis revealed no significant effect of follow-up duration for any outcome. Performing leave-one-out sensitivity analyses did not significantly change the magnitude and direction of effect for any outcome.
Conlusions
This meta-analysis found that there was no significant difference in the incidence or progression of AMD based on statin use. However, in the prevention of cardiovascular disease, statin therapy produces the most noticeable therapeutic effect in patients with strong risk factors, with a smaller effect in those with a low risk profile. A similar effect may exist in patients at risk for AMD, yet none of the included studies conducted such a subgroup analysis. Future studies should therefore aim to investigate the effect of statin use on AMD incidence in patients with high baseline risk profiles to see if the same conclusions hold true.
Financial Disclosure
MMP: Financial support (to institution) – PSI Foundation. PJK: Advisory board – Roche, Novartis, Alcon, Bayer, Novelty Nobility; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer; Equity owner – ArcticDx. RHM: Advisory board- Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.
Comments
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