Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Korea.
Ophthalmology. 2019 Feb;126(2):274-282. doi: 10.1016/j.ophtha.2018.09.014. Epub 2018 Sep 18.
The association between long-term cardioprotective aspirin use and neovascular age-related macular degeneration (AMD) is controversial. This study was undertaken to estimate the risk of neovascular AMD with long-term regular use of low-dose aspirin.
Retrospective population-based study, using a nationwide cohort from a variety of clinics and hospitals in South Korea.
Nonregular aspirin users and regular aspirin users under national health insurance, aged ≥45 years, who were followed from 2010 to 2015, were identified.
Incidence per 10 000 person-years for neovascular AMD was estimated. Long-term regular use of low-dose aspirin was defined as sustained intake of ≤100 mg aspirin with ≥1044 days prescription between 2005 and 2009. Nonregular aspirin users included occasional users or nonusers. The analyses included a propensity score-adjusted analysis in a large, randomly selected, unmatched whole cohort (n = 482 613); propensity score-matched analysis in a matched cohort (n = 74 196); and maximally adjusted analysis in the unmatched whole cohort (n = 482 613).
Incidence of newly developed neovascular AMD using the registration code for intractable disease under national health insurance.
Incidence of neovascular AMD was 3.5 among nonregular aspirin users and 7.2 among regular aspirin users per 10 000 person-years in the unmatched whole cohort. However, propensity score-adjusted analyses revealed no association between aspirin use and neovascular AMD (adjusted hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.73-1.30). Likewise, propensity score-matched analyses showed no association; incidences of neovascular AMD were 7.5 and 7.1 among nonregular aspirin users and regular aspirin users (crude HR, 0.94; 95% CI, 0.70-1.28), respectively. A maximally adjusted model, including age, sex, income, residential area, and history of 100 randomly selected types of generic drugs, showed no association (adjusted HR, 0.95; 95% CI, 0.71-1.28).
We found no association between long-term regular use of low-dose aspirin for 5 years and future incidence of neovascular AMD. Thus, this large-scale study suggests that regular, long-term use of low-dose aspirin appears to be safe with respect to the new development of neovascular AMD.
长期使用阿司匹林进行心脏保护与新生血管性年龄相关性黄斑变性（AMD）之间的关联存在争议。本研究旨在评估长期定期使用低剂量阿司匹林与新生血管性 AMD 的风险。
这是一项使用来自韩国各种诊所和医院的全国性队列进行的回顾性基于人群的研究。
确定了非定期使用阿司匹林和接受国家健康保险的定期使用阿司匹林的人群，年龄≥45 岁，随访时间为 2010 年至 2015 年。
估计新生血管性 AMD 的每 10000 人年发病率。长期定期使用低剂量阿司匹林的定义为在 2005 年至 2009 年期间持续摄入≤100mg 阿司匹林且处方≥1044 天。非定期使用阿司匹林的患者包括偶尔使用或不使用者。分析包括在大型、随机选择、未匹配的全队列（n=482613）中进行倾向评分调整分析；在匹配队列（n=74196）中进行倾向评分匹配分析；以及在未匹配的全队列（n=482613）中进行最大调整分析。
使用国家健康保险中难治性疾病的注册码确定新发生的新生血管性 AMD 的发生率。
在未匹配的全队列中，非定期使用阿司匹林者的新生血管性 AMD 发生率为每 10000 人年 3.5 例，而定期使用阿司匹林者为每 10000 人年 7.2 例。然而，倾向评分调整分析显示阿司匹林使用与新生血管性 AMD 之间无关联（调整后的危险比[HR]，0.98；95%置信区间[CI]，0.73-1.30）。同样，倾向评分匹配分析也显示无关联；非定期使用阿司匹林者和定期使用阿司匹林者的新生血管性 AMD 发生率分别为 7.5 和 7.1（未调整 HR，0.94；95%CI，0.70-1.28）。包括年龄、性别、收入、居住地区和 100 种随机选择的通用药物类型的历史在内的最大调整模型也显示无关联（调整后的 HR，0.95；95%CI，0.71-1.28）。
我们发现长期定期使用低剂量阿司匹林 5 年与新生血管性 AMD 的未来发病率之间无关联。因此，这项大规模研究表明，长期定期使用低剂量阿司匹林似乎对新生血管性 AMD 的新发展是安全的。
