Statin use may not protect against glaucoma
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Statin use was not found to be a protective strategy against glaucoma or related traits of glaucoma, according to a cross-sectional study in Investigative Ophthalmology & Visual Science.
“The relation between statin use and glaucoma has also been intensely studied and has yielded very mixed results ranging from inverse, to null, to adverse,” Jihye Kim, PhD, of the Harvard T.H. Chan School of Public Health, and colleagues wrote.
Using the UK Biobank, Kim and colleagues collected data on statin use, IOP, OCT parameters and glaucoma status to determine whether a positive relationship exists between statin use and glaucoma prevention. Data sets included 118,153 participants for study of corneal-compensated IOP; 41,638 participants for macular retinal nerve fiber layer thickness; 41,547 participants for macular ganglion cell inner plexiform layer thickness; and 192,283 participants with glaucoma status, including 8,982 cases of self-reported prevalent glaucoma.
Researchers used five nested multivariable-adjusted linear regression models, which were progressively adjusted for different covariates.
After adjusting for age, sex, ethnicity (white, Black, Asian and other), deprivation, spherical equivalent and non-statin hypolipidemic medication use, researchers observed a significant association in the first model between statin use and lower IOP (difference in IOP = 0.13 mm Hg).
The second model further adjusted for smoking status, alcohol and caffeine intake, and physical activity and yielded a slightly lower association between statin use and lower IOP (difference = 0.10 mm Hg). The third model adjusted for model-two factors as well as covariates related to metabolic syndrome, including BMI, systolic blood pressure, diabetes and cardiovascular disease, and researchers continued to observe an association between statin use and lower IOP (difference = 0.12 mm Hg).
However, after adjusting for beta-blocker use in model four (difference = 0.06 mm Hg) and serum total cholesterol level and triglyceride levels in model five (difference = 0.05 mm Hg), researchers were no longer able to make a significant association with IOP.
Statin use was not associated with prevalent glaucoma in most models but did show weak association with thinner macular retinal nerve fiber layer in model one (difference = 0.32 microns) and borderline significance in model five (difference = 0.14 microns).
Model five results also demonstrated no association with macular ganglion cell inner plexiform layer thickness and were nonsignificant (difference = 0.12 microns).
Study limitations included a lack of data on previous statin use, including dosage and length of statin use, and the fact that prevalent glaucoma was self-reported, which could bias the results, according to researchers.
“Overall, our study provides support for the possibility that statin use is not favorably associated with glaucoma-related outcomes and that statin use may not be an effective primary glaucoma prevention strategy,” Kim and colleagues wrote.
Perspective
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I often get asked by my glaucoma patients if any of their systemic conditions or medications play a part in their ocular health; a great question that is often met with limited answers. As we know, glaucoma risk increases with age, as does the risk for many conditions such as hypertension and hyperlipidemia. Not surprisingly, many of our glaucoma patients will be on multiple systemic medications to manage these conditions, which may or may not affect IOP and OCT findings.
While previous observational and database studies looking at the relationship between statins and glaucoma had mixed findings, this population-based study adds to the existing literature supporting that these cholesterol-lowering medications have no relationship – positive or negative – to glaucoma or IOP. As the authors admit, however, this study has limitations as an observational, cross-sectional study without information on dosage or duration of statin use of its participants and relying on self-reported diagnoses of glaucoma. Nonetheless, this study controlled for potentially confounding medications known to alter IOP, such as systemic beta-blockers, as well as excluding participants with neurologic conditions like Alzheimer’s and multiple sclerosis in which patients have been shown to have thinner retinal nerve fiber layer and ganglion cell-inner plexiform layer.
This study is a good reference for patients who are on common cholesterol-lowering medications, allowing us as clinicians to more confidently relay that there is no clear significant relationship between statin usage, IOP, OCT parameters and glaucoma prevalence. Keeping up-to-date about common age-related medical conditions and their respective treatment options, especially as to how they may affect the eye, becomes increasingly important in an aging population such as that of many of our glaucoma patients.
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