Statins are used widely to treat hypercholesterolemia and atherosclerotic cardiovascular disease.They have inflammatory and immunomodulatory effects potentially useful for managing systemic autoimmune diseases such as rheumatoid arthritis,lupus erythematosus and multiple sclerosis.Statins also have anti-oxidative and large-vessel endothelial supportive properties that occur independent of their lipid-lowering effects.Additionally,statins can suppress macrophage and microglial activation responsible for initiating inflammatory cytokine release.More than forty percent of adults aged 65 years or older use statins in the United States and Australia,a prevalence that increases with age.The effects of statin usage on ophthalmic practice are probably underrecognized.Cardiovascular disease and age-related macular degeneration(AMD)share common risk factors,consistent with the“vascular model”of AMD pathogenesis that implicates impaired choroidal circulation in Bruch’s membrane lipoprotein accumulation.AMD has a complex multifactorial pathogenesis involving oxidative stress,choroidal vascular dysfunction,dysregulated complement-cascade-mediated inflammation and pro-inflammatory and pro-angiogenic growth factors.Many of these components are hypothetically amenable to the primary(cholesterol lowering)and secondary(anti-inflammatory,anti-oxidative,anti-vasculopathy)effects of statin use.Experimental studies have been promising,epidemiological trails have produced conflicting results and three prospective clinical trials have been inconclusive at demonstrating the value of statin therapy for delaying or preventing AMD.Cumulative evidence to date has failed to prove conclusively that statins are beneficial for preventing or treating AMD.
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