Purpose

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.

Design

Retrospective population-based study, using a nationwide cohort from a variety of clinics and hospitals in South Korea.

Participants

Nonregular aspirin users and regular aspirin users under national health insurance, aged ≥45 years, who were followed from 2010 to 2015, were identified.

Methods

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).

Main Outcome Measures

Incidence of newly developed neovascular AMD using the registration code for intractable disease under national health insurance.

Results

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).

Conclusions

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.

中文翻译：

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长期定期服用小剂量阿司匹林与新生血管性年龄相关性黄斑变性

目的

长期使用心脏保护性阿司匹林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。这项研究的目的是评估长期定期使用小剂量阿司匹林对新生血管性AMD的风险。

设计

一项基于人群的回顾性研究，使用了来自韩国各种诊所和医院的全国性队列。

参加者

确定了2010年至2015年接受国家医疗保险的≥45岁的非常规阿司匹林使用者和常规阿司匹林使用者，并对其进行了随访。

方法

估计每10 000人年的新血管AMD发生率。长期经常使用小剂量阿司匹林的定义为：2005年至2009年之间，持续服用≤100mg阿司匹林且处方时间≥1044天。非常规阿司匹林使用者包括偶发使用者或非使用者。这些分析包括对大型随机选择的，不匹配的整个队列（n = 482 613）进行倾向得分调整的分析；匹配人群的倾向得分匹配分析（n = 74196）；并在无与伦比的整个队列中进行了最大调整的分析（n = 482 613）。

主要观察指标

根据国家健康保险，使用难治性疾病的注册码的新开发血管新生AMD的发病率。

结果

在无与伦比的整个队列中，每10 000人年中，非常规阿司匹林使用者中新血管AMD的发生率为3.5，常规阿司匹林使用者中为7.2。但是，倾向得分调整后的分析表明，使用阿司匹林与新生血管性AMD之间无关联（调整后的危险比[HR]为0.98； 95％的置信区间[CI]为0.73-1.30）。同样，倾向得分匹配的分析也没有相关性。非常规阿司匹林使用者和常规阿司匹林使用者新血管AMD的发生率分别为7.5和7.1（粗HR，0.94； 95％CI，0.70-1.28）。一个经过最大调整的模型，包括年龄，性别，收入，居住区以及100种随机选择的非专利药的历史记录，均未显示相关性（调整后的HR为0.95； 95％CI为0.71至1.28）。

结论

我们发现长期长期服用低剂量阿司匹林5年与未来血管新生AMD的发生之间没有关联。因此，这项大规模的研究表明，就新血管性AMD的新发展而言，长期，长期使用小剂量阿司匹林似乎是安全的。