Shalev Varda, Sror Miri, Goldshtein Inbal, Kokia Ehud, Chodick Gabriel
Maccabi Healthcare Services, Tel Aviv, Israel.
Ophthalmic Epidemiol. 2011 Apr;18(2):83-90. doi: 10.3109/09286586.2011.560746.
To investigate the association between persistent use of statins and the risk of age-related macular degeneration (AMD).
A population-based retrospective cohort among adults who began statin therapy between 1998 and 2006 in a large health organization in Israel. The organization's central computerized databases were used to collect data on incident AMD cases diagnosed by ophthalmologists.
A total of 108,973 individuals aged 55 or older were identified. During the study follow-up period 409,113 person-years, there were 2,732 incident AMD cases (6.68 per 1,000 person-years). The crude incidence density rate of AMD among patients at the lowest quintile of persistence with statins (7.18 per 1,000) was comparable to that of highest persistence quintile (7.13 per 1,000). After adjustment for potential confounders, patients in the highest quintile of persistence with statins had a hazard ratio of 0.99 (95% Confidence Interval: 0.78-1.26) for AMD compared with patients in the lowest proportion of days covered (PDC) quintile. In addition to age, AMD was found to associate with past smoking, asthma, diabetes and frequent visits to ophthalmologists or primary physicians prior to index date.
Our study agrees with previous studies that showed no association between persistent use of statins and reduced risk of AMD. These results suggest that the early reports on a strong protective effect of statins against AMD development were probably a result of a small study effect.
探讨长期使用他汀类药物与年龄相关性黄斑变性(AMD)风险之间的关联。
对1998年至2006年期间在以色列一家大型健康机构开始他汀类药物治疗的成年人进行基于人群的回顾性队列研究。利用该机构的中央计算机数据库收集眼科医生诊断的AMD病例数据。
共识别出108,973名55岁及以上的个体。在研究随访期409,113人年中,有2,732例AMD新发病例(每1,000人年6.68例)。他汀类药物持续使用处于最低五分位数的患者中,AMD的粗发病率密度(每1,000人7.18例)与持续使用处于最高五分位数的患者(每1,000人7.13例)相当。在对潜在混杂因素进行调整后,他汀类药物持续使用处于最高五分位数的患者与覆盖天数比例(PDC)最低五分位数的患者相比,发生AMD的风险比为0.99(95%置信区间:0.78 - 1.26)。除年龄外,还发现AMD与既往吸烟、哮喘、糖尿病以及在索引日期之前频繁就诊于眼科医生或初级医生有关。
我们的研究与之前的研究一致,即长期使用他汀类药物与降低AMD风险之间无关联。这些结果表明,早期关于他汀类药物对AMD发展具有强大保护作用的报道可能是小研究效应的结果。