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Statins and macular degeneration

 

Clinical bottom line

People who develop macular degeneration are less likely to have used statins. There is a biology that could explain a causal relationship between use of statins and delayed onset or development of macular degeneration, but as yet there is no definitive evidence to prove this treatment would work.


Reference


G McGwin et al. The association between statin use and age related maculopathy. British Journal of Ophthalmology 2003 87: 1121-1125.


Study

This was a case control study in which all patients with at least one visit to a US veterans hospital and above age 50 were eligible for inclusion. Only men were studied. All diagnoses were coded, together with information about medication prescribed, and date of prescription being filled. Cases of age related maculopathy diagnosed between 1997 and 2001 formed the cases, and for each 10 controls were selected matched for age. For each case and each control use of statins before the diagnosis date or matching date was examined, together with use of other cholesterol lowering drugs. Other information about patient demographics and other diagnoses was also collected

Results

There were 550 cases and 5,500 controls. The average age of men was 73 years, and there were higher rates of white race, diabetes, hypertension and cardiovascular and cerebrovascular disease in the cases than in the controls.

The proportion with a statin prescription filled was 7% among cases and 14% among controls, despite this higher rate of disease in cases. The odds ratio was 0.5 (95%CI 0.3 to 0.6), and this association was unchanged for present of past statin use, or with longer duration of use. The effect was present for statin users, or statin users and other lipid lowering drugs combined, but not for other lipid lowering drugs without statins.

The association was present and unchanged when the results were adjusted for confounding factors like diabetes, and was if anything stronger after adjustment.

Comment

What we have here is a very interesting association. There are other studies about statins and macular degeneration, but both were small, and the one suggesting a decreased progression of maculopathy with statins was published as a letter. But this is potentially important stuff, and clearly we need a proper randomised trial to answer the question.