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Long-Term Regular Use of Low-Dose Aspirin and Neovascular Age-Related Macular Degeneration

National Sample Cohort 2010–2015
Published:September 18, 2018DOI:https://doi.org/10.1016/j.ophtha.2018.09.014

      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.

      Abbreviations and Acronyms:

      AMD (age-related macular degeneration), CI (confidence interval), HR (hazard ratio), NHIS (National Health Insurance Service), NSC (National Sample Cohort)
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