Re: Daily aspirin use associated with development of wet and dry macular degneration

"randy@xxxxxxx" <randy@xxxxxxx> wrote in
news:69880596-acfe-4255-93bf-e42c9752078f@xxxxxxxxxxxxxxxxxxxx
ups.com:

On Jan 17, 1:22 pm, Charly Coughran
<ccough...@DELETE-TO-RESPOND- UCSD.EDU> wrote:
Susan <su...@xxxxxxxxxxxx> wrote
innews:9ndmfiF2tcU5@xxxxxxxxxxxxxxxxxx:









x-no-archive: yes

http://www.diabetesincontrol.com/index.php?option=com_cont
en
t&view=article&id=12008&catid=1&Itemid=17

Daily Aspirin Tied to Macular Degeneration
Daily aspirin use may protect the heart but hurt the
eyes, boosting the risk of AMD....

In a population-based study led by Paulus T.V.M. de
Jong, MD, PhD, of the Netherlands Institute for
Neuroscience and the Academic Medical Center, both in
Amsterdam, researchers reported that, late-stage "wet"
AMD was 2.22 times more likely among daily aspirin users
(95% CI 1.61 to 3.05).

Daily aspirin use was also significantly elevated at
earlier stages of the disease, although the association
rose with AMD severity (P<0.001 for trend), de Jong and
colleagues reported. But prior studies have yielded
conflicting results on the connection between aspirin
use and AMD, so further evaluation is needed, they
noted.

De Jong said in a press release that, "If future studies
support our results, then recommendations on aspirin may
need to be modified for patients with age-related
macular degeneration." "It's possible that increased AMD
risk may outweigh aspirin's potential protective
benefits for some patients, but we need to know more
about the impacts of dose, length of use, and other
factors before we can say for certain, or make specific
recommendations."

His group's European Eye Study included 4,691
participants ages 65 or older randomly sampled from the
population of seven European countries from Norway in
the north to Italy in the south. More than a third of
these seniors (36.4%) showed early AMD on fundus
photographs taken as part of the study, and late AMD was
found in 3.3% of participants. Most participants
reported at least some aspirin use: monthly for 41.2%,
at least once a week for 7%, and daily for 17.3%.
Notably, one-third of individuals with wet AMD took
aspirin daily compared with only 16% of those who did
not have AMD. Adjustment for age, gender, and
cardiovascular disease produced the 2.22-fold higher
risk of wet AMD associated with daily aspirin.

Wet AMD risk rose with frequency of aspirin use
(P<0.001). For the "dry" form of advanced AMD, aspirin
use didn't appear to correlate with prevalence. The lack
of an association with dry AMD may in part have been
because of the small sample size of only 49 cases, but
the researchers noted that a prior study with
substantially more dry AMD cases didn't find an
association with aspirin use either. Early AMD also
showed a link to daily aspirin use, with 26% elevated
risk of grade 1 AMD (OR 1.26, 95% CI 1.08 to 1.46)
and 42% excess risk of grade 2 AMD (OR 1.42, 95% CI 1.18
to 1.70) compared with no use after adjustment for age,
gender, and cardiovascular disease.

The association wasn't significant for grade 3 AMD, nor
was any association with less than daily use of aspirin.

The researchers acknowledged the possibility of
confounding by indication given that those with a
history of cardiovascular disease are more likely to
take daily aspirin and are also more likely to develop
wet AMD.

"However, the odds ratios for aspirin use and wet AMD
were virtually unchanged when cardiovascular disease was
included in the analysis, indicating that the
association of aspirin with AMD was independent of any
association with cardiovascular disease and was not
confounded by cardiovascular disease," they wrote.
Furthermore, the impact of daily aspirin use on AMD
didn't differ between individuals with cardiovascular
disease and those without it (P=0.06 for interaction).
More likely mechanisms are disruption of the fine
balance in lipid oxidation and that aspirin's inhibition
of cyclooxygenase 1 (COX-1) and
prostaglandin-endoperoxide synthetase 2 may cut down on
the vasodilator prostacyclin, leading to hypoxia and
neovascularization, de Jong's group suggested.
Practice Pearls:
?     This European, cross-sectional, study found that
frequent aspirin use was associated with early AMD and
wet late AMD, and the association rose with increasing
frequency of consumption. ?     Although several studies
suggested an association between aspirin use and AMD,
other studies were unable to confirm this finding. De
Jong PTVM, et al "Associations between aspirin use and
aging macula disorder: The European eye study"
Ophthalmology 2012; DOI: 10.1016/j.ophtha.2011.06.025.

One of the reasons I maintain that reading the report of a
study is much less useful than reading the actual study is
that the reports often get things wrong or leave out
important pieces of information.  This is true even in the
top tier of medical reporting of which diabetesincontrol
is a member. If you read the journal article you will find
that, "There are no data regarding the amount of aspirin
the participants used."

This is not to argue that the study is useless, but it may
not be as important as it might seem at first glance,
especially for those of us who take 81mg of aspirin on a
daily basis.  The discussion section of the paper has a
very long paragraph discussing potential shortcommings of
the study.  Always a good sign.

--
Charly Coughran
______________________
ccough...@xxxxxxxxxxxxxxxxxxxxxxxxxx

Charly,

I don't think I've ever replied directly to you posts, but
I always read them.
You never disappoint when it comes to well
reasoned,informed common sense.

Thanks!
Randy


Thank you for the kind words, but I do royally screw things up
from time to time. I depend on the kindness of others to
correct me when I do :-)

--
______________________
ccoughran@xxxxxxxxxxxxxxxxxxxxxxxxxx
.

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