AREDS: Aspirin Safe for Patients With AMD

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Patients with age-related macular degeneration (AMD) should not worry that taking aspirin after a heart attack could increase their disease progression. That’s the conclusion of the 19th report culled from the two Age-Related Eye Disease Studies (AREDS).¹

“We found that taking aspirin was not associated with an increased risk of developing AMD, either the wet or the dry form,” said Emily Y. Chew, MD, at the NEI.

The literature has been mixed on the association between aspirin, an established therapy for the secondary prevention of cardiovascular events, and the risk of progression to late AMD. However, Dr. Chew said the ro­bust nature of the AREDS and AREDS2 data gives more credence to this study’s findings than any earlier conflicting cross-sectional and population-based studies. Among the strengths are long follow-up—10 years for AREDS and five for AREDS2—plus a sufficiently large sample size of persons with AMD.

This study’s statistical methodol­ogy attempts to level the playing field by matching the patients to focus on the effect of aspirin. In addition, two previous randomized trials also showed no increased risk of AMD progression with aspirin use.^2,3

PROGRESSION. The AREDS results indicate that aspirin does not affect progression of either dry or wet AMD (shown here). This image was originally published in the ASRS Retina Image Bank. Pamela Rowlett, CRA. Exudative Macular Degeneration. Retina Image Bank. 2019; Image Number 29991. © The American Society of Retina Specialists.

Caution: Not the last word. “The obvious limitation of our study is that it is not a clinical trial,” Dr. Chew said. “It is still an association study, so we cannot prove cause and effect.” For that, she is looking to ASPREE (Aspi­rin in Reducing Events in the Elderly), which set out to investigate whether the daily use of 100 mg of enteric-coat­ed aspirin would prolong the healthy life span of older adults. Although the parent ASPREE trial concluded in January 2018, a five-year randomized substudy, ASPREE-AMD, will assess the effect of daily aspirin on the course of AMD in 5,000 subjects age 70 and older.

Until results from ASPREE-AMD are available, doctors may advise patients that aspirin is not likely to affect the progression of their AMD, Dr. Chew said. “We believe it is safe for patients who have AMD to take aspirin when indicated for other medical con­ditions.”

—Miriam Karmel

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1 Keenan TD et al. Ophthalmology. Published online June 26, 2019.

2 Christen WG et al. Arch Ophthalmol. 2001;119(8):1143-1149.

3 Christen WG et al. Ophthalmology. 2009;116(12):2386-2392.

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Relevant financial disclosures—Dr. Chew: None.

For full disclosures and the disclosure key, see below.

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