Summary: The dietary supplement AREDS2 which replaces antioxidants with lutein and zeaxanthin with beta-carotene reduces the risk of progression of age-related macular degeneration, a new study reveals.
Age-Related Eye Disease Studies (AREDS and AREDS2) found that dietary supplements can slow the progression of age-related macular degeneration (AMD), the most common cause of blindness in older Americans . In a new report, scientists analyzed 10 years of AREDS2 data.
They show that the AREDS2 formula, which replaced beta-carotene with the antioxidants lutein and zeaxanthin, not only reduces the risk of lung cancer due to beta-carotene, but is also more effective in reducing the risk of AMD progression. , compared to the original formula.
A report on the study, funded by the National Institutes of Health, published in JAMA Ophthalmology.
“Because beta-carotene increased the risk of lung cancer in current smokers in two NIH-supported studies, our goal with AREDS2 was to create an equally effective supplement formula that could be used by anyone, whether he smokes or not,” Emily Chew said. , MD, director of the Division of Epidemiology and Clinical Application at the National Eye Institute (NEI) and lead author of the study report.
“These 10-year data confirm that not only is the new formula safer, it is actually better at slowing the progression of AMD.”
AMD is a degenerative disease of the retina, the light-sensitive tissue at the back of the eye. The gradual death of retinal cells in the macula, the part of the retina that provides clear central vision, eventually leads to blindness. Treatment can slow or reverse vision loss; however, there is no cure for AMD.
The original AREDS study, initiated in 1996, showed that a dietary supplement formulation (500 mg of vitamin C, 400 international units of vitamin E, 2 mg of copper, 80 mg of zinc and 15 mg of beta-carotene) could significantly slow the progression of AMD from moderate to late disease.
However, two concurrent studies also found that people who smoked and took beta-carotene had a significantly higher risk of lung cancer than expected.
In AREDS2, launched in 2006, Chew and his colleagues compared the beta-carotene formulation to a formulation containing 10 mg of lutein and 2 mg of zeaxanthin instead. Like beta-carotene, lutein and zeaxanthin are antioxidants with activity in the retina. The beta-carotene-containing training was only given to participants who had never smoked or who had quit smoking.
At the end of the AREDS2 five-year study period, the researchers concluded that lutein and zeaxanthin did not increase the risk of lung cancer and that the new training may reduce the risk of lung cancer progression. AMD of about 26%.
After the end of the five-year study period, study participants were all offered the final AREDS2 training which included lutein and zeaxanthin instead of beta-carotene.
In this new report, researchers followed 3,883 of the original 4,203 AREDS2 participants for an additional five years from the end of the AREDS2 study in 2011, collecting information on the progression of their AMD to late disease and on the whether they had been diagnosed with lung cancer.
Even though all participants switched to the formula containing lutein and zeaxanthin after the end of the study period, the follow-up study continued to show that beta-carotene nearly doubled the risk of lung cancer in people who had ever smoked.
There was no increased risk of lung cancer in people receiving lutein/zeaxanthin.
Additionally, after 10 years, the group initially assigned to receive lutein/zeaxanthin had an additional 20% reduced risk of progression to late AMD compared to those initially assigned to receive beta-carotene.
“These results confirmed that switching our formula from beta-carotene to lutein and zeaxanthin was the right choice,” Chew said.
Funding: The study was funded by the NEI intramural program (EY000546) and through contracts (AREDS2 contract HHS-N-260-2005-00007-C; ADB contract NO1-EY-5-0007; AREDS contract NOI -EY-0-2127, and contract HHS-N-263-2013-00005-C).
AREDS2 contracts have been supported by the NIH Office of Dietary Office of Dietary Supplements, National Center for Complementary and Integrative Health, National Institute on Aging, National Heart, Lung, and Blood Institute, and National Institute of Neurological Disorders and Stroke .
The study took place at the NIH Clinical Center.
About this Age-Related Macular Degeneration Research News
Author: Lesley Earl
Contact: Lesley Earl – NIH
Image: Image is in public domain
Original research: Access closed.
“Long-term results of adding lutein/zeaxanthin and ω-3 fatty acids to AREDS supplements on the progression of age-related macular degeneration” by Chew EY, et al. JAMA Ophthalmology
Long-term results of adding lutein/zeaxanthin and ω-3 fatty acids to AREDS supplements on the progression of age-related macular degeneration
After the Age-Related Eye Disease Study 2 (AREDS2), the beta-carotene component was replaced with lutein/zeaxanthin for the development of the revised AREDS supplement. However, it is unclear whether the increased risk of lung cancer observed in people receiving beta-carotene persists beyond the conclusion of the AREDS2 trial and whether there is a benefit to adding lutein/zeaxanthin to the original AREDS supplement that can be observed in the long term. follow.
To assess the 10-year risk of developing lung cancer and late age-related macular degeneration (AMD).
Design, framework and participants
This was a multicenter epidemiological follow-up study of the AREDS2 clinical trial, conducted from December 1, 2012 to December 31, 2018. The analysis included participants with bilateral or unilateral intermediate AMD for an additional 5 years after the trial clinical. Eyes/participants were censored at the time of late AMD development, death, or loss to follow-up. Data was analyzed from November 2019 to March 2022.
During the clinical trial, participants were randomly assigned primarily to lutein/zeaxanthin and/or ω-3 fatty acids or placebo and secondarily to no beta-carotene versus beta-carotene and at low or high doses of zinc. In the epidemiological follow-up study, all participants received AREDS2 supplements containing lutein/zeaxanthin, vitamins C and E, and zinc plus copper. Outcomes were assessed in phone calls at 6 months. Analyzes of AMD progression and lung cancer development were conducted using proportional hazards regression and logistic regression, respectively.
Main results and measures
Self-reported lung cancer and late AMD validated with medical records.
This study included 3882 participants (mean [SD] original age, 72.0 [7.7] years; 2240 women [57.7%]) and 6351 eyes. At 10 years, the odds ratio (OR) of having lung cancer was 1.82 (95% CI, 1.06-3.12; P= 0.02) for those randomly assigned to beta-carotene and 1.15 (95% CI, 0.79-1.66; P= 0.46) for lutein/zeaxanthin.
The hazard ratio (HR) for progression to late AMD comparing lutein/zeaxanthin versus no lutein/zeaxanthin was 0.91 (95% CI, 0.84-0.99; P= 0.02) and comparing ω-3 fatty acids to no ω-3 fatty acids was 1.01 (95% CI, 0.93-1.09; P= 0.91).
When the main effects analysis of lutein/zeaxanthin was restricted to people randomly assigned to beta-carotene, the RR was 0.80 (95% CI, 0.68-0.92; P= .002).
A direct analysis of lutein/zeaxanthin versus beta-carotene showed that the HR for late AMD was 0.85 (95% CI, 0.73-0.98; P= .02). The HR for low zinc versus high zinc was 1.04 (95% CI, 0.94-1.14; P= 0.49), and the RR for no beta-carotene versus beta-carotene was 1.04 (95% CI, 0.94-1.15; P= 0.48).
Conclusions and relevance
The results of this long-term epidemiological follow-up study of the AREDS2 cohort suggest that lutein/zeaxanthin was an appropriate replacement for beta-carotene in AREDS2 supplements. Beta-carotene use nearly doubled the risk of lung cancer, whereas there was no statistically significant increased risk with lutein/zeaxanthin. Compared to beta-carotene, lutein/zeaxanthin had a potential beneficial association with late AMD progression.