Secondary Analyses of the Effects of Lutein/Zeaxanthin on Age-Related Macular Degeneration Progression AREDS2 Report No. 3

被引：311

作者：

Chew, Emily Y. ^{[1
]}

Clemons, Traci E. ^{[2
]}

SanGiovanni, John Paul ^{[2
,3
]}

Danis, Ronald P. ^{[4
]}

Ferris, Frederick L. ^{[5
]}

Elman, Michael J. ^{[6
]}

Antoszyk, Andrew N. ^{[7
]}

Ruby, Alan J. ^{[8
]}

Orth, David ^{[9
]}

Bressler, Susan B. ^{[10
]}

Fish, Gary E. ^{[11
]}

Hubbard, George Baker ^{[12
]}

Klein, Michael L. ^{[13
]}

Chandra, Suresh R. ^{[14
]}

Blodi, Barbara A. ^{[14
,15
]}

Domalpally, Amitha ^{[14
]}

Friberg, Thomas ^{[16
]}

Wong, Wai T. ^{[17
]}

Rosenfeld, Philip J. ^{[18
]}

Agron, Elvira ^{[5
]}

Toth, Cynthia A. ^{[19
]}

Bernstein, Paul S. ^{[20
]}

Sperduto, Robert D.

机构：

[1] NIH, Div Epidemiol & Clin Res, Bethesda, MD 20892 USA

[2] EMMES Corp, Rockville, MD USA

[3] NEI, Clin Trials Branch, Bethesda, MD 20892 USA

[4] Univ Wisconsin Madison, Dept Ophthalmol, Bethesda, MD USA

[5] NEI, Bethesda, MD 20892 USA

[6] Elman Retina Grp, Baltimore, MD USA

[7] Charlotte Eye Ear Nose & Throat, Charlotte, NC USA

[8] William Beaumont Hosp, Associated Retinal Consultants, Royal Oak, MI 48072 USA

[9] Ingalls Mem Hosp, Harvey, IL USA

[10] Johns Hopkins Univ Hosp, Wilmer Eye Inst, Dept Ophthalmol, Baltimore, MD 21287 USA

[11] Texas Retina Associates, Dallas, TX USA

[12] Emory Univ, Atlanta, GA 30322 USA

[13] Oregon Hlth & Sci Univ, Casey Eye Inst, Dept Ophthalmol, Portland, OR USA

[14] Univ Wisconsin Madison, Dept Ophthalmol & Visual Sci, Sch Med & Publ Hlth, Madison, WI USA

[15] Univ Wisconsin Madison, Fundus Photograph Reading Ctr, Madison, WI USA

[16] Univ Pittsburgh, Sch Med, Dept Ophthalmol, Pittsburgh, PA 15261 USA

[17] NEI, Unit Neuron Glia Interact Retinal Dis, NIH, Bethesda, MD 20892 USA

[18] Bascom Palmer Eye Inst, Dept Ophthalmol, Miami, FL 33136 USA

[19] Duke Univ, Med Ctr, Durham, NC USA

[20] Univ Utah, Hlth Sci Ctr, Moran Eye Ctr, Dept Ophthalmol & Visual Sci, Salt Lake City, UT USA

来源：

JAMA OPHTHALMOLOGY | 2014年 / 132卷 / 02期

基金：

美国国家卫生研究院;

关键词：

LONG-TERM INCIDENCE; FATTY-ACID INTAKE; EYE DISEASE; CIGARETTE-SMOKING; FISH CONSUMPTION; BETA-CAROTENE; RISK-FACTORS; DIETARY-FAT; VITAMIN-A; ASSOCIATIONS;

D O I：

10.1001/jamaophthalmol.2013.7376

中图分类号：

R77 [眼科学];

学科分类号：

100212 ;

摘要：

IMPORTANCE The Age-Related Eye Disease Study (AREDS) formulation for the treatment of age-related macular degeneration (AMD) contains vitamin C, vitamin E, beta carotene, and zinc with copper. The Age-Related Eye Disease Study 2 (AREDS2) assessed the value of substituting lutein/zeaxanthin in the AREDS formulation because of the demonstrated risk for lung cancer from beta carotene in smokers and former smokers and because lutein and zeaxanthin are important components in the retina. OBJECTIVE To further examine the effect of lutein/zeaxanthin supplementation on progression to late AMD. DESIGN, SETTING, PARTICIPANTS The Age-Related Eye Disease Study 2 is a multicenter, double-masked randomized trial of 4203 participants, aged 50 to 85 years, at risk for developing late AMD; 66% of patients had bilateral large drusen and 34% had large drusen and late AMD in 1 eye. INTERVENTIONS In addition to taking the original or a variation of the AREDS supplement, participants were randomly assigned in a factorial design to 1 of the following 4 groups: placebo; lutein/zeaxanthin, 10 mg/2 mg; omega-3 long-chain polyunsaturated fatty 3 acids, 1.0 g; or the combination. MAIN OUTCOMES AND MEASURES Documented development of late AMD by central, masked grading of annual retinal photographs or by treatment history. RESULTS In exploratory analysis of lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratio of the development of late AMD was 0.90 (95% CI, 0.82-0.99; P = .04). Exploratory analyses of direct comparison of lutein/zeaxanthin vs beta carotene showed hazard ratios of 0.82 (95% CI, 0.69-0.96; P = .02) for development of late AMD, 0.78 (95% CI, 0.64-0.94; P = .01) for development of neovascular AMD, and 0.94 (95% CI, 0.70-1.26; P = .67) for development of central geographic atrophy. In analyses restricted to eyes with bilateral large drusen at baseline, the direct comparison of lutein/zeaxanthin vs beta carotene showed hazard ratios of 0.76 (95% CI, 0.61-0.96; P = .02) for progression to late AMD, 0.65 (95% CI, 0.49-0.85; P = .002) for neovascular AMD, and 0.98 (95% CI, 0.69-1.39; P = .91) for central geographic atrophy. CONCLUSION AND RELEVANCE The totality of evidence on beneficial and adverse effects from AREDS2 and other studies suggests that lutein/zeaxanthin could be more appropriate than beta carotene in the AREDS-type supplements.

引用

页码：142 / 149

页数：8

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