Yonsei Med J.  2019 Jul;60(7):679-686. 10.3349/ymj.2019.60.7.679.

Effect of Statins, Metformin, Angiotensin-Converting Enzyme Inhibitors, and Angiotensin II Receptor Blockers on Age-Related Macular Degeneration

• Lee H
• Jeon HL
• Park SJ
• Shin JY

• KMID: 2450408
• DOI: http://doi.org/10.3349/ymj.2019.60.7.679

Abstract

PURPOSE
Statins, metformin, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) have been suggested for treating age-related macular degeneration (AMD) due to their pleiotropic effects. Therefore, we investigated whether these drugs prevent AMD.
MATERIALS AND METHODS
We conducted a nested case-control study using the Korean National Health Insurance Service database. Using risk-set sampling of age, sex, cohort entry date, and follow-up duration, we identified incident patients with AMD and 10 matching controls in cohorts with diabetes mellitus or cardiovascular diseases. Exposure was assessed within one year before the index date using patient prescription records. We conducted conditional logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the association between cardiovascular medications and AMD.
RESULTS
Our study included 2330 cases and 23278 controls from a cohort of 231274 patients. The ORs (95% CI) for AMD occurrence in users prescribed with statins, metformin, ACE inhibitors, and ARBs were 1.12 (0.94-1.32), 1.15 (0.91-1.45), 0.90 (0.61-1.34), and 1.21 (1.05-1.39), respectively. A duration-response was not observed.
CONCLUSION
Statins, metformin, ACE inhibitors, and ARBs did not inhibit AMD in elderly patients. The absence of a duration-response supports the lack of a causal relationship.

Keyword

Age-related macular degeneration; preventive effect; cardiovascular medications

MeSH Terms

Aged
Angiotensin II*
Angiotensin Receptor Antagonists*
Angiotensin-Converting Enzyme Inhibitors*
Angiotensins*
Cardiovascular Diseases
Case-Control Studies
Cohort Studies
Diabetes Mellitus
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Logistic Models
Macular Degeneration
Metformin*
National Health Programs
Odds Ratio
Prescriptions
Receptors, Angiotensin*
Angiotensin II
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Angiotensins
Metformin
Receptors, Angiotensin

Figure

• 

  Fig. 1 Flowchart of study cohort construction. *Cohort entry date was matched with the cohort entry date of the cases, ranging from 30 days before or after the entry date.

• 

  Fig. 2 Subgroup analyses of the associations between AMD and exposures according to the type of AMD and presence of cerebrovascular diseases. *Adjusted for income level, Charlson comorbidity index, the number of prescriptions, cerebrovascular disease history, complicated or uncomplicated diabetes, hyperlipidemia, hypertension and peripheral vascular disease, and the use of alpha-blockers, alpha-glucosidase, aspirin, beta-blockers, calcium channel blockers, diuretics, meglitinide, sulfonylurea, or thiazolidinedione. AMD, age-related macular degeneration; ACE inhibitors, angiotensin-converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; aORs, adjusted odds ratios; CI, confidence interval.

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