Statins (2011, '13, '16, '17) & Cataract Risk
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Depending on the methodology used, there has been research suggesting that statins increase cataract use and that it does not increase the risk. The general consensus is that for heart patients, the increased risk is less than the increased risk of circulation problems without the statins.
A study published on behalf of the American Heart Association reported no increased risk. The study was a meta analysis which looked at results only and did not take into account statin-years, a method used in earlier studies that measured both dosage and duration of statin use. They found that cohort studies (studies that look at the causes of diseases) found a moderate increased risk. They found that case-control studies (studies that compare a test group to a control group) did not see any increased risk. However they did note that risk was less for younger patients and greater for older patients.
S. Yu, Y. Chu, et al, Statin Use and the Risk of Cataracts: A Systematic Review and Meta-Analysis, Journal of the American Heart Association, March, 2017.
A population-based study of more than 134 thousand statin patients in Italy who were newly prescribed statins over a 2 year period. The researchers identified patients who had cataract or lens extraction surgery and matched them with up to 5 random controls matched by gender, age, date of prescription, etc. The researchers used logistic regression to investigate low, medium and high usage of statins. They identified over 1,300 statin patients and over 6,600 controls, with a mean age of 70, slightly more than half of whom were men. They identified a trend of cataract development as statin dosage and duration increased.
M. Casula, D. Soranna, Statin use and risk of cataract: A nested case-control study within a healthcare database, Atherosclerosis, August, 2016.
Another 2016 study of over 6,000 patients in the US found that statins taken continuously for at least one year may have increased risk. 42% of the statin users needed cataract surgery; 34% of statin users did not need cataract surgery.
AREDS2 The large Age-Related Eye Disease Study 2, No. 8, however, did report increased risk of cataracts with statin use. AREDS2 was designed to investigate the addition of lutein and zeaxanthin and omega-3 fatty acids (found in AREDS2 to decrease macular degeneration risk). AREDS2 found that these nutrients did not make up a significant improvement for cataract patients. However the data collected allowed researchers to investigate the possible association between cataract and statin use. 42% of the cataract patients used statins. These patients were more likely to have high blood pressure or cardiovascular problems; they tended to be men, to smoke and/or have diabetes.
Both male and female statin users were found to have an increased risk of developing cataracts.
S.H. Al-Holou, W.R. Tucker, et al, The Association of Statin Use with Cataract Progression and Cataract Surgery The Age-Related Eye Disease Study 2 Report Number 8, Ophthalmology, April, 2016.
This study utilized the data from a large military health care system and looked at patients who had received a minimum of a 90 day prescription of statins versus patients who had not. The researchers selected almost 14,000 statin users and almost 33,000 non-statin users.
The analysis method is known as propensity score-matching, a method, which to some mathemeticians increases imbalances and bias. However in this study the patients and controls were matched in over 40 factors to eliminate bias and create 6,972 pairs of patient/control.
The showed an increased risk of cataract development of 9% to 27% and up to 34% in a study analysis. The variance in risk is associated with duration and dosage of the statin use.
J. Leuschen, E.M. Mortensen, et al, Association of statin use with cataracts: a propensity score-matched analysis, JAMA Ophthalmology, November, 2013.
Investigators reviewed information from more than two million people in England and Wales, ages 30 to 84, in the QResearch medical database between 2002 and 2008. Of that group, 225,992 were new users of one of the following statins: simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol), rosuvastatin (Crestor), or fluvastatin (Lescol).
The investigators found that statin use was associated with an increased risk of cataracts in both men and women. The risk of cataracts rose within one year of starting statin treatment, persisted during treatment, and then returned to normal within a year after discontinuing the statin.
Bottom line: This study was not designed to show whether statins could cause cataracts, but it does show an association between the two. These findings conflict with other recent studies that have found that statins may prevent cataract development. More studies are needed to provide a definitive answer. In the meantime, it's important to see your eye doctor regularly to monitor for cataracts and other eye diseases.