效力问题：他汀类药物强度在调节年龄相关性黄斑变性风险中的作用。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-08-18 DOI:10.1016/j.ajo.2025.08.024

Zain S. Hussain , Muhammad Z. Chauhan , Jawad Muayad , Asad Loya , Wendy Nembhard , Ahmed B. Sallam

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引用次数: 0

摘要

重要性：老年性黄斑变性（AMD）是视力丧失的主要原因。他汀类药物主要用于心血管疾病预防，可能对AMD有多效作用，但现有证据尚无定论。目的：探讨他汀类药物强度（高、中、低）与2型糖尿病合并血脂异常患者AMD风险的关系。设计、设置和参与者：一项回顾性临床队列研究，使用来自美国协作网络的去识别电子健康记录。2014 - 2024年，年龄在40岁及以上的2型糖尿病、血脂异常且至少有一次眼科就诊的成年人被纳入研究对象。排除有混淆性疾病（肝病、HIV等）和既往AMD诊断的患者。倾向评分匹配用于平衡他汀类药物强度队列和treatment-naïve对照组之间的协变量。暴露：高强度他汀治疗（瑞舒伐他汀20- 40mg或阿托伐他汀40- 80mg）、high-intensity-naïve、中等强度他汀治疗（瑞舒伐他汀（5mg、10mg）、辛伐他汀（20mg、40mg）、氟伐他汀（80mg）、普伐他汀（40mg、80mg）、洛伐他汀（40mg）、阿托伐他汀（10mg、20mg）或匹伐他汀（1mg、2mg、4mg））和低强度他汀治疗（辛伐他汀5- 10mg、普伐他汀10- 20mg、洛伐他汀10- 20mg或氟伐他汀20- 40mg）。主要结局和指标：合并性AMD（非渗出性和渗出性）、非渗出性AMD、渗出性AMD的发病率，以及指标事件发生后6个月、1年、3年和5年的全因死亡率。采用Cox比例风险回归模型估计风险比（hr）和95% ci。结果：匹配后，共纳入患者20282例。高强度他汀类药物的使用与3年和5年合并AMD的风险降低相关（HR分别为0.74 （95% CI: 0.57-094）和0.79 (95% CI: 0.62-0.98)）。在所有随访点，中等强度他汀类药物治疗与合并AMD (HR范围：0.49 （95% CI: 0.55-0.91）至0.77 （95% CI: 0.60-0.98）和渗出性AMD (HR范围：0.19（0.06-0.054）至0.62 （95% CI: 0.40-0.96）的风险显著降低相关。所有他汀类药物剂量均与全因死亡率降低相关。结论和相关性：在这项针对2型糖尿病和血脂异常患者的研究中，中、高强度，而非低强度，他汀类药物治疗与AMD风险降低相关。需要进一步的研究来证实这些发现并阐明潜在的机制。

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Potency Matters: The Role of Statin Intensity in Modulating Risk for Age-Related Macular Degeneration

Purpose

Age-related macular degeneration (AMD) is a leading cause of vision loss. Statins, primarily used for cardiovascular disease prevention, may have pleiotropic effects on AMD, but existing evidence is inconclusive.

This study investigated the association between statin intensity (high, moderate, low) and the risk of AMD in patients with type 2 diabetes and dyslipidemia.

Design

A retrospective clinical cohort study using de-identified electronic health records from the US Collaborative Network.

Methods

Adults aged 40 years or older with type 2 diabetes, dyslipidemia, and at least 1 ophthalmologic visit were included from 2014 to 2024 Patients with confounding conditions (liver disease, HIV, etc.) and prior AMD diagnoses were excluded. Propensity score matching was used to balance covariates between statin intensity cohorts and a treatment-naïve control group.

Intensity groups included: high-intensity statin therapy (rosuvastatin 20-40 mg or atorvastatin 40-80 mg), high-intensity-naïve, medium-intensity statin therapy (rosuvastatin [5 mg, 10 mg], simvastatin [20 mg, 40 mg], fluvastatin [80 mg], pravastatin [40 mg, 80 mg], lovastatin [40 mg], atorvastatin [10 mg, 20 mg], or pitavastatin [1 mg, 2 mg, 4 mg]), and low-intensity statin therapy (simvastatin 5-10 mg, pravastatin 10-20 mg, lovastatin 10-20 mg, or fluvastatin 20-40 mg).

Main Outcome Measures

Incidence of combined AMD (nonexudative and exudative), nonexudative AMD, exudative AMD, and all-cause mortality at 6 months, 1 year, 3 years, and 5 years after the index event. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazard regression models.

Results

After matching, a total of 20 282 patients were included. High-intensity statin use was associated with a reduced risk of combined AMD at 3 and 5 years (HR: 0.74 (95% CI: 0.57-094) and 0.79 (95% CI: 0.62-0.98), respectively). Medium-intensity statin therapy was associated with a significantly lower risk of combined AMD (HR range: 0.49 [95% CI 0.55-0.91] to 0.77 [95% CI: 0.60-0.98]) and exudative AMD (HR range: 0.19 [0.06-0.054] to 0.62 [95% CI: 0.40-0.96]) at all follow-up points. All statin intensities were associated with reduced all-cause mortality.

Conclusions

In this study of patients with type 2 diabetes and dyslipidemia, medium- and high-intensity, but not low-intensity, statin therapies were associated with a reduced risk of AMD. Further research is needed to confirm these findings and elucidate the underlying mechanisms.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.