Statins (2006) and Macular Degeneration

2006

Recent recommendations for the aggressive use of medications to lower low-density lipoprotein (LDL) cholesterol levels has contributed to a rising trend in the use of statin drugs. A study published in the January 2006 Archives of Ophthalmology evaluates the use of these drugs, specifically with regard to the risk of age-related macular degeneration (AMD).

The investigators collected data from the Cardiovascular Health Study, a population-based prospective study, to address the relationship between the use of statins and other cholesterol-lowering medications and AMD. Fundus photographs were taken in 1997 and 1998 on 4249 statin users and non-statin users in the study. 2755 of these participants were available to be classified as cases (AMD) or controls (no AMD).

The results of this study suggests no association exists between cholesterol-lowering medications and AMD progression. However, there was a suggestion that statin use might increase the risk of developing AMD. These findings are corroborated in several similar studies, including the first National Health Examination and Nutrition Survey. This evidence may seem a bit contrary to some and more than disappointing to the pharmaceutical companies who are now using the popular atherosclerotic-like theory of AMD to justify detailing statin drugs as AMD medications in ophthalmic offices.

The Doctors Klein (Beaver Dam Study) recently proposed the idea that high LDL levels and low HDL levels may actually offer protection from AMD by down-regulating LDL receptors in the Retinal Pigment Epithelium (RPE), thereby reducing the contribution of cholesterol to drusen. This line of reasoning implies that by lowering serum cholesterol levels with statins; an increased amount of cholesterol may be taken up by the RPE cells with a subsequent increased deposition in drusen and an increased risk of AMD.

References:

3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors and the Presence of Age-Related Macular Degeneration in the Cardiovascular Health Study. McGwin G, Kayvon M, et al. Arch Ophthalmol. January 2006;124(1):33-37 [abstract not yet catalogued in the National Library of Medicine]

A case control study of age related macular degeneration and use of statins. Smeeth L, Cook C, et al. Br J Ophthalmol. 2005 Sep;89(9):1171-5 [abstract]

The association of cardiovascular disease with the long-term incidence of age-related maculopathy: the Beaver Dam eye study. Kelin R, Klein BE, et al. Ophthalmology. 2003 Apr;110(4):636-43 [abstract]

The Use of Cholesterol-lowering medications and Age-related macular degeneration McGwin Jr G, Xie A, et al. Ophthalmology 2005;112:488-494 [abstract]

Cholesterol lowering drugs and risk of age related maculopathy: prospective cohort study with cumulative exposure measurement. van Leeuwen R, Vingerling JR, Hofman A, et al. BMJ 2003;326:255-256 [abstract]

Relation of statin use to the 5-year incidence and progression of age-related maculopathy. Klein R, Klein BE, et al. Arch Ophthalmol. 2003 Aug;121(8):1151-5 [abstract]