JAMA：长期服用阿司匹林与年龄相关的黄斑变性风险增加有关

据发表在12月19日刊《美国医学会杂志》上的一项研究披露，在近5000名试验参与者中，至少在10年的时间里经常性地服用阿斯匹林与新生血管性、与年龄相关的黄斑变性风险的小幅，但却具有显着统计学意义的增加有关。

麦迪逊的威斯康星大学医学与公共卫生学院的Barbara E. K. Klein, M.D., M.P.H.及其同事开展了一项研究，旨在检查服用阿斯匹林与和年龄相关的黄斑变性（AMD）之间的关系。研究人员使用的数据来自Beaver Dam Eye Study，这是一项在威斯康星州开展的基于人口的，对年龄相关性眼疾的纵向研究。在一个为期20年的时段中（1988-1990年至2008-2010年），研究参与者每隔5年会做一次检查。研究参与者(n = 4,926) 在进入研究时的年龄为43-86岁。在接受随后的检查时，参与者会被问及他们是否会超过3个月每周至少2次经常性地服用阿斯匹林。随访的平均时间为14.8年。

在这项研究中，研究人员对不同类型的AMD（早期、晚期及2种晚期AMD的亚型[即新生血管性AMD及单纯性地图样萎缩]）的发病率进行了测量。

在这项研究的过程中，早期AMD有512个新诊断病例，晚期AMD有117个新诊断病例。研究人员发现，在视网膜检查之前10年经常性地服用阿斯匹林与晚期AMD有关（经年龄及性别校正的发病率：服用阿斯匹林者为1.8% vs.非阿斯匹林服用者为1.0%）。在检查其与晚期AMD亚型的关系时，新生血管性AMD与服用阿斯匹林有显着的关系（经年龄和性别校正的发病率：服用阿斯匹林者为1.4% vs.非阿斯匹林服用者为0.6%），但纯粹地图样萎缩则不然。视网膜检查前5年或10年服用阿斯匹林与早期AMD的新诊断的发病率没有关系。

文章的作者得出结论：“我们的发现和经常服用阿斯匹林与新生血管性AMD的发病率之间有着小幅但具有统计学显着意义的关系是一致的。要证实我们的观察需要做额外的重复工作。如果获得证实，定义因果机制可能对研发阻断这种作用的方法从而在服用阿斯匹林的人——尤其是那些为了预防CVD的人——中防止或延缓新生血管性AMD的发生是重要的。”

与阿司匹林相关的拓展阅读：

• Circulation：真性阿司匹林药物抵抗罕见
• NEJM:华法林与阿司匹林在心脏射血分数降低患者中的疗效比较
• J NATL CANCER I：阿司匹林或可预防肝癌
• Arch Neurol：阿司匹林抵抗与梗死面积和严重程度相关
• NEJM：阿司匹林可预防静脉血栓栓塞复发
更多信息请点击：有关阿司匹林更多资讯

doi:10.1001/jama.2012.65406.
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Long-term Use of Aspirin and Age-Related Macular Degeneration

Barbara E. K. Klein, MD, MPH; Kerri P. Howard, MS; Ronald E. Gangnon, PhD; Jennifer O. Dreyer, BS; Kristine E. Lee, MS; Ronald Klein, MD, MPH

Context Aspirin is widely used for relief of pain and for cardioprotective effects. Its use is of concern to ophthalmologists when ocular surgery is being considered and also in the presence of age-related macular degeneration (AMD). Objective To examine the association of regular aspirin use with incidence of AMD. Design, Setting, and Participants The Beaver Dam Eye Study, a longitudinal population-based study of age-related eye diseases conducted in Wisconsin. Examinations were performed every 5 years over a 20-year period (1988-1990 through 2008-2010). Study participants (N = 4926) were aged 43 to 86 years at the baseline examination. At subsequent examinations, participants were asked if they had regularly used aspirin at least twice a week for more than 3 months. Main Outcome Measure Incidence of early AMD, late AMD, and 2 subtypes of late AMD (neovascular AMD and pure geographic atrophy), assessed in retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System. Results The median duration of follow-up was 14.8 years. There were 512 incident cases of early AMD (of 6243 person-visits at risk) and 117 incident cases of late AMD (of 8621 person-visits at risk) over the course of the study. Regular aspirin use 10 years prior to retinal examination was associated with late AMD (hazard ratio [HR], 1.63 [95% CI, 1.01-2.63]; P = .05), with estimated incidence of 1.76% (95% CI, 1.17%-2.64%) in regular users and 1.03% (95% CI, 0.70%-1.51%) in nonusers. For subtypes of late AMD, regular aspirin use 10 years prior to retinal examination was significantly associated with neovascular AMD (HR, 2.20 [95% CI, 1.20-4.15]; P = .01) but not pure geographic atrophy (HR, 0.66 [95% CI, 0.25-1.95]; P = .45). Aspirin use 5 years (HR, 0.86 [95% CI, 0.71-1.05]; P = .13) or 10 years (HR, 0.86 [95% CI, 0.65-1.13]; P = .28) prior to retinal examination was not associated with incident early AMD. Conclusions Among an adult cohort, aspirin use 5 years prior to observed incidence was not associated with incident early or late AMD. However, regular aspirin use 10 years prior was associated with a small but statistically significant increase in the risk of incident late and neovascular AMD.