In the JournalsPerspective

Statin use associated with risk of cataract development

Patients who used statins had a greater risk of cataract development than those who did not use statins, according to a large study.

The retrospective cohort study included 46,249 patients who met all study inclusion criteria; 13,626 patients were statin users and 32,623 were nonusers.

Investigators used 44 variables to create a propensity score-matched cohort comprising 6,972 pairs of users and nonusers. A secondary analysis included 6,113 statin users and 27,400 nonusers.

Cataract diagnoses were based on ICD-9 codes and the type and cause of cataract.

Statin users received the drugs for at least 90 days. Among users, 73.5% of statin prescriptions were for simvastatin, 17.4% for atorvastatin, 7% for pravastatin, 1.7% for rosuvastatin and 0.24% for fluvastatin or lovastatin.

Among the score-matched cohort, statin users had significantly greater risk of developing cataract than nonusers (P = .01). Adjusted data in the secondary analysis showed that users with no comorbidities had a markedly higher risk of developing cataract (P = .003), the authors said.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.

Patients who used statins had a greater risk of cataract development than those who did not use statins, according to a large study.

The retrospective cohort study included 46,249 patients who met all study inclusion criteria; 13,626 patients were statin users and 32,623 were nonusers.

Investigators used 44 variables to create a propensity score-matched cohort comprising 6,972 pairs of users and nonusers. A secondary analysis included 6,113 statin users and 27,400 nonusers.

Cataract diagnoses were based on ICD-9 codes and the type and cause of cataract.

Statin users received the drugs for at least 90 days. Among users, 73.5% of statin prescriptions were for simvastatin, 17.4% for atorvastatin, 7% for pravastatin, 1.7% for rosuvastatin and 0.24% for fluvastatin or lovastatin.

Among the score-matched cohort, statin users had significantly greater risk of developing cataract than nonusers (P = .01). Adjusted data in the secondary analysis showed that users with no comorbidities had a markedly higher risk of developing cataract (P = .003), the authors said.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.

    Perspective

    The relationship between statin usage and cataract formation is unclear. Studies have been conflicting in their conclusions. This retrospective observational study found a positive association between statin usage and cataracts. The study was statistically powerful in that a large number of study subjects were included (13,626 statin users and 32,623 nonusers). Additionally, because the subjects were all enrolled in the same health care system (military) and health insurance plan, bias was minimized in terms of health care access and usage. Furthermore, the authors adjusted for baseline confounders of cataract formation among the statin users and nonusers.

    Nevertheless, the limitations of the study are also noteworthy. Firstly, the study was retrospective. Secondly, diagnosis of cataract was simply determined by an ICD-9 code. No evidence of ophthalmic examination was sought. Similarly, no slit lamp characteristics of progressive cataract formation for the duration of observation were included, nor were any measures of visual significance acquired. It is not even clear if the subjects had any ophthalmic examinations. Thus, although this study sought to answer an important question and had statistical merits to it, the conclusions drawn may be erroneous due to critically important data that are missing.

    • Elizabeth A. Davis, MD, FACS
    • OSN Cataract Surgery Board Member

    Disclosures: Davis has no relevant financial disclosures.