December 2, 2014

New Study Strengthens Evidence of the Connection Between Statin Use and Cataracts

PHILADELPHIA -- December 2, 2014 -- A study published in the Canadian Journal of Cardiology showed an increased risk for cataracts in patients treated with statins.

In previous studies the association between statin use and cataracts has been inconsistent and controversial.

The current study used data from the British Columbia (BC) Ministry of Health databases from 2000 to 2007 and the IMS LifeLink US database from 2001 to 2011 to form 2 patient cohorts. The BC cohort was composed of female and male patients; 162,501 cases were matched with 650,004 controls. The IMS LifeLink cohort was comprised of males only, aged 40 to 85 years; 45,065 cases were matched with 450,650 controls.

Patients using statins for more than 1 year prior to initial ophthalmology examination were identified. Diagnosis and surgical management of cataracts were followed.

In the BC cohort, there was about a 27% increased risk of developing cataracts requiring surgical intervention (adjusted risk ratio [RR], 1.27). In the IMS cohort, the increased risk was only 7%, but still significant.

The adjusted RRs for long-term regular use of specific statins in the BC cohort ranged from 1.14 to 1.42. In the IMS cohort, the adjusted RRs for individual statins varied within a narrow range from 1.03 to 1.14. The investigators did not determine whether certain statins were worse than others, but most confidence intervals overlapped suggesting a class effect.

“Further assessment of the clinical impact of this relationship is recommended, especially given increased statin use for primary prevention of CVD [cardiovascular disease] and the importance of acceptable vision in old age where CVD is common,” said G.B. John Mancini, MD, Department of Medicine, University of British Columbia, Vancouver, British Columbia. “Future studies addressing the possible underlying mechanisms to explain this association are also warranted. However, because the RR is low and because cataract surgery is both effective and well tolerated, this association should be disclosed but not be considered a deterrent to use of statins when warranted for CV risk reduction.”

In an accompanying editorial, Steven Gryn, MD, and Robert A. Hegele, MD, Schulich School of Medicine and Dentistry, Western University, London, Ontario, wrote: “Any medication that has beneficial effects has potential adverse effects; weighing the benefits against the risks is an integral part of the informed consent process, and is central to any decision to initiate treatment. Among patients who are at high CVD risk, like most of those seen by cardiologists...the prevention of CVD, stroke, and their associated morbidity and mortality vastly outweighs the risk of cataracts. Even among lower risk patients, for whom the benefit-risk ratio is less dramatic, most patients would still probably prefer having to undergo earlier non-life-threatening cataract surgery over suffering a major vascular event.”

In any observational study, there can be unknown confounders that could introduce bias. Both the study itself and the commentary note this weakness, but both agree that this study, while not putting the issue to rest, does add significantly to the accumulated knowledge about the statin-cataract connection. However, as Dr. Hegele noted, “a randomised double-blinded placebo-controlled clinical trial is the best way to mitigate confounding, and such studies so far have shown no association of statins with cataracts.”

SOURCE: Elsevier Health Sciences
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