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Cholesterol-lowering drugs may be linked to cataract risk
Type 2 diabetes and statin use was found to be associated with increased odds of nuclear sclerosis, cortical cataract and posterior subcapsular cataract.
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The use of statin drugs, HMG-CoA reductase inhibitors, and type 2 diabetes may be linked to increased risk of age-related cataracts, according to a recent study.
Patient files from the Waterloo Eye Study database were reviewed from January 2007 to January 2008 for overall prevalence of statin use for patients with type 2 diabetes (n = 452) and without diabetes (n = 5,884). In patients older than 38 years, statins were used by 56% of those with type 2 diabetes and 16% for those without diabetes.
Type 2 diabetes was significantly associated with nuclear sclerosis and cortical cataract. Statin use was associated with nuclear sclerosis and posterior subcapsular cataract.
“We found this association, and it is an issue. However, we don’t want to be alarmists and have people start doing things that would not be beneficial to them,” study author Elizabeth L. Irving, OD, PhD, said in an interview with Primary Care Optometry News. “If you’re going to die from a stroke or a heart attack because you don’t take these drugs, I think that’s a bigger risk than if you get a cataract that eventually someone will remove and restore you to reasonably good vision.”
According to the World Health Organization, cardiovascular diseases are the number one cause of death globally, with an estimated 7.3 million deaths from coronary heart disease and 6.2 million due to stroke in 2008.
Statins reduce cardiovascular risks in patients with diabetes, even those without high-LDL cholesterol, so they are commonly prescribed in these patients, according Colhoun and colleagues.
“The take-home message for the clinician is that there is an increased risk of getting cataracts at an earlier age if you are taking the drugs; if you are also diabetic, it makes it even earlier,” Irving said. “[But] we’re not talking about cause here, we’re just talking about an association.”
In 2010, Hippisley-Cox and Coupland looked at data from a population-based cohort study of 368 general practices in the U.K., analyzing the unintended effects of statins. For cataracts, there was no evidence of a dose-response relation, but time-varying analysis showed an increased risk within a year of statin use, which persisted during treatment and returned to normal within the first year after stopping treatment.
Machan, Hrynchak and Irving found that the probability of age-related cataracts in patients who used statins reached 50% at age 51.7 for patients with type 2 diabetes and at age 54.9 for patients without diabetes. In patients who did not use stains, it was at ages 55.1 and 57.3 for patients with type 2 diabetes and without diabetes, respectively.
The “clinically meaningful difference” of 5.6 years of developing age-related cataracts earlier in type 2 diabetic patients is an encouragement to develop alternative medications for lowering cholesterol that are not associated with an increased risk of cataract development, the study authors wrote.
“Regardless of the outcome of further study, the benefits of stain use in people with type 2 diabetes are anticipated to continue to outweigh any associated risk with age-related cataracts,” they concluded. – by Cheryl DiPietro
References:
- Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CADS): Multicenter, randomized, placebo-controlled trial.
- Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the research database. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus id dolor est.
- Machan CM, Hrynchak PK, Irving EL. Age-related cataract is associated with type 2 diabetes and statin use.
For more information:
- Elizabeth L. Irving, OD, PhD, can be reached at the University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; elirving@uwaterloo.ca.