Association of lipid-lowering and antidiabetic drugs with age-related macular degeneration: a meta-analysis in Europeans Summary Background/objectives To investigate the association of commonly used systemic medications with prevalent age-related macular degeneration (AMD) in the general population. Methods 38,694 adults were included from 14 population-based and hospital-based studies of the European Eye Epidemiology consortium. We examined associations between systemic medication use and any prevalent AMD, as well as any late AMD, using a multivariable logistic regression model by study and pooling results using a random-effects meta-analysis. Results Across studies, mean age ranged from 61.5±7.1 to 82.6±3.8 years and prevalence ranged from 12.1% to 64.5% and 0.5% to 35.5%. for any AMD and late AMD, respectively. In meta-analysis of fully adjusted multivariable models, lipid-lowering drugs (LLDs) and antidiabetic drugs were associated with lower prevalence of AMD (OR 0.85, 95% CI = 0.79 to 0.91 and OR 0.78 , 95% CI = 0.66 to 0.91). ). We found no association with late AMD or with any other medication. Conclusion Our study indicates a possible beneficial effect of LLD and antidiabetic medication use on AMD prevalence in multiple European cohorts. Our findings support the importance of metabolic processes in the multifactorial etiology of AMD. |
What is already known about the topic
Previous studies suggested an association of the use of specific systemic medications with the prevalence of age-related macular degeneration (AMD). However, these studies were often based on small and mainly clinical cohorts and reported partially contradictory results.
What does this study contribute?
This is the first large-scale study to show an association between the use of lipid-lowering and antidiabetic drugs with a lower prevalence of AMD in the general population using data from multiple European cohort studies.
How it affects clinical practice
These findings have implications for public health messages, highlight the link of AMD with cardiovascular comorbidities, and may provide potential future therapeutic targets.
Comments
Regular use of drugs to lower cholesterol and control type 2 diabetes may lower the risk of the degenerative eye disease associated with aging, known as AMD, according to a pooled data analysis of available evidence, published online in the British Journal of Ophthalmology .
These common medications are linked to a lower prevalence of AMD (age-related macular degeneration) in European populations, results show.
AMD is the leading cause of severe visual impairment among older people in high-income countries. In Europe alone, 67 million people currently suffer from the condition, and new cases are expected to skyrocket in the coming decades as the population ages.
AMD affects central vision and the ability to see fine details. Several genetic and environmental factors associated with aging are thought to trigger AMD, but it is still unclear how best to prevent it or slow its progression.
Previously published research suggests that medications to lower cholesterol, control diabetes, and decrease inflammation may help lower the risk of developing AMD, but these findings were partly contradictory and based on a small number of participants.
In an attempt to get around these problems, researchers combined results from 14 population-based and hospital-based studies, involving 38,694 people from France, Germany, Greece, Ireland, Italy, Norway, Portugal, Russia and the United Kingdom.
The studies were part of the European Eye Epidemiology (E3) consortium, a collaborative pan-European network, whose main objective is to develop and analyze large pooled data sets to improve the understanding of eye diseases and vision loss.
Participants were over 50 years old and taking at least one of the following types of cholesterol-lowering medications, including statins; manage diabetes, including insulin; to dampen inflammation, excluding steroids; and levodopa, used to treat movement disorders caused by neurodegenerative diseases.
The prevalence of AMD ranged from 12% to 64.5% in the included studies (9332 cases in total), while the prevalence of advanced (late) AMD ranged from 0.5% to 35.5% ( 951 cases in total).
Analysis of pooled data showed that medications to lower cholesterol or control diabetes were associated, respectively, with a 15% and 22% lower prevalence of any type of AMD, after accounting for potentially influential factors.
No such associations were found for any of the other types of medications or for advanced AMD, in particular, although there were only a relatively small number of such cases, the researchers note.
Theirs is the first large pooled data analysis of its kind that uses individual-level data from several population-based and hospital-based studies, the researchers note. “However, more longitudinal data are needed to confirm our findings, which are inherently limited by using only cross-sectional data and cannot infer causality,” they warn.
But the findings point to a likely key role for metabolic processes in the development of AMD, which could offer potential new avenues for treatment and have implications for public health messaging, they suggest.
“Our study suggests that regular intake of [lipid-lowering] and antidiabetic medications is associated with a reduced prevalence of AMD in the general population. Given the possible interference of these drugs with the relevant pathophysiological pathways in AMD, this may contribute to a better understanding of the etiology of AMD," they conclude.
