Aspirin Anguish

A report this week came to my attention that has linked a higher rate of macular degeneration with those who take aspirin on a regular basis.  Macular degeneration is a slowly progressive disease leading to blindness.  It is due to abnormal blood vessels in the back of the eye and becomes worse with age.  It is a frightening diagnosis to receive.  The news media seems to have very little interest these days in education and is rather more concerned about sensationalism.  This is the type of story that they love to scare people with.  I feel this deserves more thought and consideration.

The first issue lies in the fact that the study under consideration is retrospective.  This means that they took people who have the condition and looked back at factors that could be associated with it.  These types of studies are useful for generating questions for further study but are not in and of themselves definitive.  A prospective study is much better.  In this case, a group of people would be defined and divided into two groups.  One group would receive aspirin and the other would not. After a specified period of time, the two groups would be compared to see if one developed macular degeneration at a faster rate than the other.  This is not how the current study was performed.  Looking backwards can identify associations more so than establishing cause and effect.  One needs to ask, is aspirin the cause of the macular degeneration or could there be a different association.  As macular degeneration is a vascular (blood vessel) disease, I wonder if aspirin was just a marker for those who are at higher risk for vascular disease in general.  Aspirin has been shown conclusively in men over 45 and women over 55 to lower the risk of heart disease and stroke.  This is especially true in those who have risk factors such as high blood pressure, elevated cholesterol, smokers and diabetics.  Those at higher risk for vascular disease are likely to have a higher risk for macular degeneration as well.  Given their risk factors, such patients are more likely to have aspirin recommended to them by their doctors.  It is quite possible that if the patients who are found to have macular degeneration are taken off of their aspirin, they could have worsening of their macular degeneration.  They will certainly be at higher risk for the life ending complications of heart attack and stroke.

Aspirin use in the appropriate setting has been ranked by the U.S. Preventive Task Force as the single most effective way to save lives of any measure that we currently employ to prevent diseases.  This includes mammograms, pap smears, colonoscopies, blood pressure control, cholesterol management, etc. The single most effective!  Remember, your vision won't help you if you are dead.  Further studies are in order to determine the exact nature of the relationship between aspirin use and macular degeneration.  In the meantime, if you have risk factors for blood vessel disease, please talk to your doctor prior to considering stopping a potentially live prolonging medication, your simple aspirin a day.