Lutein/zeaxanthin an appropriate substitute for beta carotene in AREDS2

Supplementation with lutein/zeaxanthin instead of beta carotene is safe and does not contribute to an increase in lung cancer risk while having a potential beneficial effect on the risk of progression to late age-related macular degeneration (AMD), according to data from the Age-Related Eye Disease Study 2 (AREDS2) study.

Researchers evaluated the 10-year risk of developing lung cancer and late AMD in 3,882 AREDS2 participants (mean baseline age 72.0 years, 57.7 percent female) and 6,351 eyes. During the study, these participants were randomized primarily to receive lutein/zeaxanthin and/or ω-3 fatty acids or placebo and secondarily to receive no beta carotene vs beta carotene and low vs high doses of zinc.

In the epidemiologic follow-up study, all participants received AREDS2 supplements with lutein/zeaxanthin, vitamins C and E, and zinc plus copper. Outcomes were assessed at 6-month telephone calls.

Regression analysis of 10-year data showed that beta carotene was positively associated with lung cancer (odds ratio [OR], 1.82, 95 percent confidence interval [CI], 1.06–3.12; p=0.02); no such association was seen for lutein/zeaxanthin (OR, 1.15, 95 percent CI, 0.79–1.66; p=0.46).

In terms of the risk of progression to late AMD, supplementation with lutein/zeaxanthin vs nonreceipt was beneficial (hazard ration [HR], 0.91, 95 percent CI, 0.84–0.99; p=0.02), whereas supplementation with ω-3 fatty acids vs nonreceipt had a null effect (HR, 1.01, 95 percent CI, 0.93–1.09; p=0.91). When the effect of lutein/zeaxanthin was evaluated in the subgroup of participants who received beta carotene, the HR was 0.80 (95 percent CI, 0.68–0.92; p=0.002).

Further analysis showed that compared with beta carotene, lutein/zeaxanthin had a positive effect on late AMD (HR, 0.85, 95 percent CI, 0.73–0.98; p=0.02). This effect was not seen with low vs high zinc or no beta carotene vs beta carotene.