Statin use linked to risk for cataracts
Patients treated with statins for CVD prevention were more likely than nonusers to develop cataracts requiring surgical treatment, researchers reported in the Canadian Journal of Cardiology.
Researchers evaluated data from two cohorts selected from the British Columbia Ministry of Health databases (2000-2007) and the IMS LifeLink database (2001-2011) to identify patients who were diagnosed with and underwent surgery for cataracts. The British Columbia cohort comprised 162,501 men and women and 650,004 matched controls and the IMS LifeLink cohort comprised 45,065 men and 450,650 matched controls.
Within the British Columbia cohort, the adjusted rate ratio for cataracts requiring surgery with any statin use was 1.27 (95% CI, 1.24-1.3). The risk increase was observed in new users (adjusted RR=1.36; 95% CI, 1.3-1.42) and prior users (adjusted RR=1.24; 95% CI, 1.2-1.27). Long-term regular use of each individual statin evaluated was associated with greater risk for cataracts requiring surgical intervention, with RRs ranging from 1.14 (95% CI, 1.04-1.26) for lovastatin to 1.42 (95% CI, 1.27-1.59) for rosuvastatin (Crestor, AstraZeneca).
Within the IMS LifeLink cohort, the adjusted RR for cataracts requiring surgery among with any statin use was 1.07 (95% CI, 1.04-1.1). Analysis of individual statins indicated significantly greater risk with use of simvastatin (RR=1.05; 95% CI, 1-1.11), atorvastatin (RR=1.07; 95% CI, 1.02-1.12) and lovastatin (RR=1.14, 95% CI, 1.04-1.26). The same association was not observed with fluvastatin, rosuvastatin or pravastatin.
Researchers calculated an age-adjusted absolute risk for cataracts requiring surgery among statin users in the British Columbia cohort of 20 cases per 1,000 person-years compared with 15 per 1,000 person-years among nonusers. The age-adjusted absolute risk in the IMS LifeLink cohort was 24 per 1,000 person-years among statin users compared with 20 per 1,000 person-years among nonusers.
“This study found statin use to be significantly associated with increased risk for cataract leading to surgical intervention,” the researchers concluded. “… Further assessment of the clinical effect of this relationship is recommended, especially in light of increased statin use for primary prevention of CVD and the importance of acceptable vision in old age, when CVD is common.” However, due to the low RR and high efficacy and safety of cataract surgery, the link between statins and cataract development should be disclosed to patients, but not considered a deterrent to statin use for CVD prevention, they wrote.
Robert A. Hegele
In a related editorial, Steven E. Gryn, MD, FRCPC, and Robert A. Hegele, MD, FRCPC, from the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, noted that these results contribute to “previously hazy” literature on the link between cataracts and statins, but that the issue has yet to be clearly resolved.
“For those of us who have prescribed high doses of statins for almost 3 decades, there is certainly no epidemic of cataracts among our longtime lipid clinic patients,” they wrote. “Nevertheless, if the findings of Wise et al are confirmed, physicians might need to factor in this potential risk when discussing statin use with patients.”
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Disclosure: One researcher reports receiving honoraria from Amgen, AstraZeneca, Merck, Pfizer and Sanofi Aventis. Hegele reports CME honoraria and advisory board consultation for Aegerion, Amgen, Sanofi and Valeant. Gryn reports consulting for Novartis.