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Association of lipid-lowering drugs and antidiabetic drugs with age-related macular degeneration: a meta-analysis in Europeans
  1. Matthias M Mauschitz1,
  2. Timo Verzijden2,3,
  3. Alexander K Schuster4,
  4. Hisham Elbaz4,
  5. Norbert Pfeiffer4,
  6. Anthony Khawaja5,6,
  7. Robert N Luben5,6,
  8. Paul J Foster5,
  9. Franziska G Rauscher7,8,
  10. Kerstin Wirkner7,8,
  11. Toralf Kirsten7,8,9,
  12. Jost B Jonas10,11,
  13. Mukharram M Bikbov12,
  14. Ruth Hogg13,
  15. Tunde Peto5,13,
  16. Audrey Cougnard-Grégoire14,
  17. Geir Bertelsen15,16,
  18. Maja Gran Erke17,18,
  19. Fotis Topouzis19,
  20. Dimitrios A Giannoulis19,
  21. Caroline Brandl20,21,
  22. Iris M Heid20,
  23. Catherine P Creuzot-Garcher22,
  24. Pierre-Henry Gabrielle22,
  25. Hans-Werner Hense23,
  26. Daniel Pauleikhoff24,
  27. Patricia Barreto25,26,27,
  28. Rita Coimbra25,
  29. Stefano Piermarocchi28,29,
  30. Vincent Daien30,31,32,
  31. Frank G Holz1,
  32. Cecile Delcourt14,
  33. Robert P Finger1
  34. On behalf of the European Eye Epidemiology (E3) Consortium
  1. 1 Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
  2. 2 Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands
  3. 3 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
  4. 4 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
  5. 5 NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
  6. 6 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  7. 7 Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, 04107 Leipzig, Germany
  8. 8 Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, 04103 Leipzig, Germany
  9. 9 Leipzig University Medical Center, Medical Informatics Center - Dept. of Medical Data Science, 04107 Leipzig, Germany
  10. 10 Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
  11. 11 Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
  12. 12 Ufa Eye Research Institute, Ufa, Russia
  13. 13 Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
  14. 14 Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Team LEHA, F-33000 Bordeaux, France
  15. 15 Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
  16. 16 Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
  17. 17 Directorate of eHealth, Oslo, Norway
  18. 18 Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
  19. 19 Department of Ophthalmology, Aristotle University of Thessaloniki, School of Medicine, AHEPA Hospital, Thessaloniki, Greece
  20. 20 Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
  21. 21 Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
  22. 22 Department of Ophthalmology, University Hospital Dijon, Dijon, France
  23. 23 University of Münster, Faculty of Medicine, Institute of Epidemiology, Münster, Germany
  24. 24 Department of Ophthalmology, St. Franzikus-Hospital, Münster, Germany
  25. 25 AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
  26. 26 Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal
  27. 27 Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal
  28. 28 Padova-Camposampiero Hospital, Padova, Italy
  29. 29 University of Padova, Department of Neuroscience, Padova, Italy
  30. 30 Department of Ophthalmology, Gui de Chauliac Hospital, F-34000 Montpellier, France
  31. 31 Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, F-34091 Montpellier, France
  32. 32 The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Matthias M Mauschitz, Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; matthias.mauschitz{at}


Background/aims To investigate the association of commonly used systemic medications with prevalent age-related macular degeneration (AMD) in the general population.

Methods We included 38 694 adults from 14 population-based and hospital-based studies from the European Eye Epidemiology consortium. We examined associations between the use of systemic medications and any prevalent AMD as well as any late AMD using multivariable logistic regression modelling per study and pooled results using random effects meta-analysis.

Results Between studies, mean age ranged from 61.5±7.1 to 82.6±3.8 years and prevalence ranged from 12.1% to 64.5% and from 0.5% to 35.5% for any and late AMD, respectively. In the meta-analysis of fully adjusted multivariable models, lipid-lowering drugs (LLD) and antidiabetic drugs were associated with lower prevalent any AMD (OR 0.85, 95% CI=0.79 to 0.91 and OR 0.78, 95% CI=0.66 to 0.91). We found no association with late AMD or with any other medication.

Conclusion Our study indicates a potential beneficial effect of LLD and antidiabetic drug use on prevalence of AMD across multiple European cohorts. Our findings support the importance of metabolic processes in the multifactorial aetiology of AMD.

  • drugs
  • epidemiology

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Study data may be available upon reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Study data may be available upon reasonable request.

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  • Contributors MMM and RPF contributed to the conception and design, analysed data and wrote the initial version of the manuscript. TV, AKS, HE, NP, AK, RNL, PJF, FGR, KW, TK, JBJ, MMB, RH, TP, AC-G, GB, MGE, FT, DAG, CB, IMH, CPC-G, P-HG, H-WH, DP, PB, RC, SP, VD, FGH and CD performed data collection, contributed to study design and wrote the manuscript. All authors read and approved the final manuscript. Guarantor: MMM.

  • Funding The Alienor study received financial support from Laboratoires Théa (Clermont-Ferrand, France). Laboratoires Théa participated in the design of the study, but no sponsor participated in the collection, management, statistical analysis and interpretation of the data, nor in the preparation, review or approval of the present manuscript. The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (‘Stiftung Rheinland-Pfalz fuer Innovation’, contract AZ 961-386261/733), the research programmes ‘Wissen schafft Zukunft’ and ‘Center for Translational Vascular Biology (CTVB)’ of the Johannes Gutenberg University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study. AKS holds the professorship for ophthalmic healthcare research endowed by 'Stiftung Auge' and financed by 'Deutsche Ophthalmologische Gesellschaft' and 'Berufsverband der Augenärzte Deutschland e.V.'. AugUR: Investigations and analyses are supported by grants from the German Federal Ministry of Education and Research (BMBF 01ER1206, BMBF 01ER1507 to IMH), by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; HE 3690/7-1 and HE 3690/5-1 to IMH, BR 6028/2-1 to CB) and by the National Institutes of Health (NIH R01 EY RES 511967 to IMH). MARS (Münster Aging and Retina Study) was supported by Deutsche Forschungsgemeinschaft (DFG) Grants HE 2293/5-1, 5-2, 5-3 and PA 357/7-1, the Intramural International Monetary Fund of the University of Muenster, the Pro Retina Foundation and the Jackstaedt Foundation (DP, HWH). The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136). The clinic for the third health examination was funded by Research into Ageing (262). We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. AK is funded by a UKRI Future Leaders Fellowship (Medical Research Council MR/T040912/1). RNL is funded by a Moorfields Eye Charity Springboard Award. PJF is supported by an unrestricted grant from Alcon and the Desmond Foundation. This publication is supported by the Leipzig Research Centre for Civilization Diseases (LIFE), an organisational unit affiliated to the Medical Faculty of Leipzig University. LIFE is funded by means of the European Union, by the European Regional Development Fund (ERDF) and by funds of the Free State of Saxony within the framework of the excellence initiative (project numbers: 713-241202, 14505/2470, 14575/2470). FGR is supported by a grant from the German Federal Ministry of Education and Research: i:DSem—Integrative data semantics in systems medicine (031L0026). The authors wish to express their sincere thanks to the participants of LIFE-Adult for their time. The authors gratefully acknowledge KW and her team at the Leipzig Research Center for Civilization Diseases (LIFE-Adult), Leipzig University, Leipzig, Germany for data acquisition. The NICOLA study is funded by the Atlantic Philanthropies, the Economic and Social Research Council, the UKCRC Centre of Excellence for Public Health Northern Ireland, the Centre for Aging Research and Development in Ireland, the Office of the First Minister and Deputy First Minister, the Health and Social Care Research and Development Division of the Public Health Agency, the Wellcome Trust/Wolfson Foundation and Queen’s University Belfast. CRESCENDO study was carried out with the financial support of the ANR—Agence Nationale de la Recherche (MALZ-007-01—The French National Research Agency—and grants from the “Chercheur d’Avenir” (R12028FF) and Aide à la Recherche en Partenariat avec les Entreprises (ARPE; RPH12007F) allocated by the Languedoc Roussillon administrative regional district (France). The Coimbra Eye Study was funded by Novartis.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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