In case you missed it, an article was published in the journal JAMA Internal Medicine (formerly the Archives of Internal Medicine) on January 21st titled “The Association of Aspirin Use with Age-Related Macular Degeneration [AMD].” We felt it was newsworthy and so you will find an overview of the study in our Health News this week.
The editors of JAMA Internal Medicine were very cautious about this research. First, it was an “observational” study. That means it is not the kind of gold-standard research we need to draw definitive conclusions. The best studies are randomized, placebo-controlled trials. Second, an “eloquent Invited Commentary” by Kaul and Diamond about the research concludes that “The association between regular aspirin exposure and the risk of AMD is modest…”
Finally, and most important, the editors explain their concerns about publishing this research:
“The eloquent Invited Commentary by Kaul and Diamond illustrates the great care that must be taken before concluding that an association described in an observational study truly represents a cause-effect relationship. In our discussion of the article by Liew and colleagues, the editors believed that it provided useful incremental data about an important condition. However, as with many good studies, the data are not definitive enough to suggest changes in clinical practice. Rather, we hope the study galvanizes more research on the relationship between aspirin and macular degeneration.
“After the editors decided to accept this article, we discussed the risk that press reports would fall into the trap of reporting this study as definitive. This study provides an opportunity to educate the public about the subtleties and incremental nature of medical research.”

The editors had reason to be concerned. Much of the subtlety of this study was lost in the following headlines:
“Study links aspirin to blindness”
“Long-term aspirin use linked with increased risk of blindness”
“Aspirin users could double risk of blindness in old age”
“Study: Aspirin use increases blindness risk among elderly”
“Aspirin use may cause age-related blindness”

The headlines are likely to scare the dickens out of most readers. Few will forget the words “aspirin and blindness.” Even if an article points out that association is not causation, that subtlety is likely to be forgotten. Also ignored may be the fact that age-related macular degeneration is relatively uncommon (prevalence of about 1.5% in the American population). Even a doubling of risk still means that there is a relatively small absolute risk of developing this problem with regular aspirin use.
The authors of this research point out that their study confirms findings from another observational study which also found a two-fold increased risk of AMD among regular aspirin users. But what was pretty much ignored in the news reports was their ackowldgement that two large, gold-standard randomized clinical trials (The Physicians’ Health Study and the Women’s Health Study) reported “no increased AMD risk during 7 to 10 years among aspirin users.”
So, What’s the Bottom Line on Aspirin and AMD?
Age-related macular degeneration is certainly worrisome. Even though it is relatively rare it does lead to blindness in as many as 500,000 Americans. That is why it is essential to get regular eye exams to detect any signs of this disease at the earliest stages. This condition can often be treated with some new medications such as Lucentis (ranibizumab), Avastin (bevacizumab), Eylea (aflibercept), Macugen (pegaptanib) or Visudyne (verteporfin). There is also laser photocoagulation therapy.
• The story on aspirin and AMD is confusing. The data are clearly not definitive. If the risk exists, it takes 10 to 15 years to show up. We will need long-term randomized, double-blind studies to establish a cause and effect relationship.
• What should we all do in the meantime? The authors of this research conclude that there is “insufficient evidence to recommend changing clinical practice” regarding aspirin use. In other words, if your doctor believes that aspirin is important for reducing the risk of cardiovascular disease (heart attacks or strokes) or cancer, it is best to follow that advice and not discontinue aspirin suddenly because of scary headlines.
• If an eye exam reveals the early stages of age-related macular degeneration, it is essential to discuss the dangers of continued aspirin use.
What is your experience with AMD? Have you received treatment? Has it worked? Were you satisfied? Have you experienced AMD after long-term regular aspirin use? We would love to hear your story below.
If you have friends who might have read one of those scary headlines about aspirin and AMD, please send this story to them via email or Twitter or Facebook (you will find an icon to click at the top of this article to the right of the headline). And when you do, please suggest that they might like to sign up for our free electronic newsletters (put their email address in the box in the upper right hand corner under Subscriptions).
Should you wish to listen to a radio interview about the pros and cons of aspirin we offer “Aspirin Secrets Revealed,” Show # 842). It tells about the latest research involving aspirin against cancer.
We also have a FREE Guide to Key Aspirin Information.
We try to bring you the stories behind the health headlines and explain the subtleties that are often left out of the popular press. Please let us know how we did with this complex aspirin story.

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  1. s.h.
    Reply

    Eight years ago, my eye doctor told me that if I didn’t want any more bleeders in my eyes, I needed to stop taking my daily baby aspirin. I stopped taking aspirin by tapering….yes, even tapered baby aspirin.

  2. john
    Reply

    For a 70-year-old who has been on .81mg for many years and has early signs of MD, questions arise. One would hope the doctors will have time to actually talk to one another and agree on a recommendation; otherwise the patient will have to make his own calculation. I am appreciative to the People’s Pharmacy.
    PEOPLE’S PHARMACY RESPONSE: We definitely urge you to discuss this research with both your regular doctor and your eye doctor!

  3. Karen
    Reply

    Thank you for the additional information, which adds further questions:
    Australia has much worse UV exposure than most of the United States. Probably, therefore, higher baseline D3 levels. Don’t know anything about the correlation between skin cancers and AMD. Do the people who die of melanoma at a young age take themselves out of the pool of people who would otherwise develop AMD later in life?

  4. DIK V
    Reply

    I am 86 and have been taking an aspirin each day since a med student told me about the benefits in 1970. So, after some 40+ years, I am not going to stop now.

  5. SNH
    Reply

    DS: Where did you get the idea that heart disease was ever “rare”??

  6. Karen
    Reply

    >Please let us know how we did with this complex aspirin story.
    Better than normal, because it is a complex story. Unfortunately, in the very same email, you have another link to the same story not covered anywhere nearly as thoroughly.
    >http://www.peoplespharmacy.com/2013/01/24/aspirin-use-linked-to-macular-degeneration/
    Comment here, comment there, follow what people are saying try to keep your website links straight in my mind. Not clear why this newsletter needed two links to the same core story.
    N = 1 apocryphal story from an un-named eye doctor says that macular degeneration is primarily a Caucasian problem, while African Americans need to worry more about glaucoma. Ethnicity not addressed in the article.
    Of all the risk factors for eye problems, it seems to me that regular aspirin use is simply the easiest to ask about, and therefore possibly the easiest to raise red flags over. Inquiring minds want to know:
    HOW MUCH ASPIRIN IS “REGULAR?” For crying out loud, this HAS to be dose-dependent. 81mg / day? Hands-full every four hours? What about all the other NSAIDs? Surely the study asked how MUCH aspirin people were taking?
    Then there are all the other variables: Colored vegetables in the diet, over years. Exposure to sun / UV and sunglass wearing habits; the demographics of AMD suggest people with AMD today are of the generation that thought tanning was “cool,” not just for poor farm workers, and were ahead of the sunscreen addiction we have now. What are the VitD levels of the people with and without AMD?
    I understand that it is not possible for the PP to report on data that aren’t addressed in the study itself.
    It would also be useful to know if the people who got AMD from aspirin might otherwise have died from the conditions that aspirin helped to prevent. THERE’S a double-blind that will never get past the ethics committee…
    PEOPLE’S PHARMACY RESPONSE: The study was conducted in Australia (the Blue Mountains Eye Study) and the authors note that the 10% taking regular aspirin were PROBABLY using the most common cardiovascular prevention dose prescribed in Australia, 150 mg. Not a dose readily available in the US, but certainly higher than our 81 mg “heart” dose.
    The Blue Mountain Eye Study has collected tons of information on diet (this was the study showing that fish eaters are less susceptible to AMD). None of that was included in this study, though, and it isn’t clear that they ran regression analyses to see if it mattered. No data on ethnicity, but the mix is different in Australia than in the U.S. although European extraction was probably the main background of the participants.
    The researchers did collect information on blood pressure, BMI and other risk factors, including a genetic factor. They did point out that the benefits of aspirin use in preventing second heart attacks, etc., might very well have outweighed the risks of AMD for these individuals.

  7. Yoly
    Reply

    I have a related question regarding aspirin. I am used to buying aspirin that is labeled “aspirin.” Now it is it labeled “aspirin NSAID.” Are these the same?
    Yoly
    NM
    PEOPLE’S PHARMACY RESPONSE: Aspirin is a type of NSAID. Read the label to make sure that aspirin is the only pain reliever in your pill.

  8. Ark
    Reply

    Again, let us be careful and reiterate that no drug can be regarded as “miracle” drug….including aspirin. It’s so amusing that some of friends who have no knowledge of medicine and/or alternative means, confidently say that “don’t worry” just take one aspirin first thing in the morning!!
    I subscribe to a news letter who advocates CAM all the time. It is so interesting that what he says now in his news letter becomes headlines in the regular media anywhere from 5 to 10 years down the road. One of the example was demonization of eggs. I am watching with great interest that he is and has been totally against using a daily aspirin regimen. And if this story further develop to the extent with conclusion in future to for the recommendation to avoid this regimen, by George, he will be right again.
    Let’s watch this carefully and see what happen.
    Thanks.

  9. DS
    Reply

    WHY is it important to follow a doctor’s advice since he is probably misinformed? It seems there is a lot of misinformation out there. I think misinformation has killed a lot of people in the past half-century. Heart disease was rare until doctors climbed onto the “saturated fat is evil” bandwagon.
    PEOPLE’S PHARMACY RESPONSE: It is important for patients to do their own homework and find a well-informed doctor with whom they can interact in a partnership.

  10. tappy
    Reply

    As I recall from reading a different summary, only wet form of amd and not the dry form were associated with aspirin. Don’t recall seeing the strength of aspirin mentioned either.
    PEOPLE’S PHARMACY RESPONSE: You are correct. Only the wet form of macular degeneration was associated with aspirin use. The usual dose of aspirin in Australia for heart protection is 150 mg–about half a regular tablet here.

  11. Mary
    Reply

    I don’t know if taking aspirin is worth the risks. There are the stomach issues as well as this possible link to AMD.

  12. Pat J
    Reply

    My father had age-related macular degeneration and he had taken BC powders like candy for 20+ years…coincidence? Probably not.

  13. charles
    Reply

    All articles are very informative. Serious research seems to be a goal. When you let people know more study has to take place on a article, and inform people not to stop a program given by their doctor, until more research is conducted, this makes a good report and allows the reader to check further on their individual situation and as we all should do, ASK QUESTIONS.

  14. raggmopp
    Reply

    My husband has been on a baby aspirin a day regime since the mid 1980’s and is suffering from AMD, which was diagnosed sometime in the 1990’s and is now going into a more advanced stage. He has had the laser treatment as well as injections when some blood blister (for lack of the proper term) was found in the back of one eye. Now he is continuing the aspirin theraphy, along with plavix, following the installation of a stent, even though it’s past the normal year after. The doctor said it was a stoke prevention theraphy.

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