CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

September 20th, 2013

Taking a Clear-Eyed View of Statins and Cataracts

Past observational studies have turned up conflicting findings about the effects, if any, of statins on developing cataracts. Now a large new observational study finds a small but significant increase in cataracts in statin users, however, experts warn that without further support the new finding should probably not influence clinical practice.

In a paper published in JAMA Ophthalmology, Jessica Leuschen and colleagues analyzed data from a military health care system. In their primary analysis they performed a propensity analysis comparing 6,972 propensity-matched pairs of statin users and nonusers. The authors reported a significant 9% increased risk among statin users compared with nonusers (odds ratio 1.09, CI 1.02-1.17). Secondary analyses, and a sensitivity analysis based on duration of statin treatment, appeared to confirm the association. The authors said that their study was less likely to reflect bias from health care accessibility and use because of the military setting.

The authors concluded:

The risk for cataract is increased among statin users as compared with nonusers. The risk-benefit ratio of statin use, specifically for primary prevention, should be carefully weighed, and further studies are warranted.”

However, in a comment for NEJM Journal Watch,  JoAnne Foody said:

“Data on whether statins increase risk for cataracts remain inconclusive and conflicting. For now clinicians should continue to weigh individual patient … benefits and potential harms in determining whether statins are the right choice for a given patient.”

Another statin expert who wishes to remain anonymous said that even if cataract risk was increased by a small amount, the substantial benefits of statin therapy would continue to outweigh the risks, especially since treatment for cataracts is extremely safe and effective.

 

 

Categories: General, Prevention
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2 Responses to “Taking a Clear-Eyed View of Statins and Cataracts”

  1. John Ryan, MD says:
    September 20, 2013 at 5:13 pm

    Cataracts occurred in 35.5% of statin users versus 33.5% of non-statin users, so not exactly a game changer or a reason to avoid statins, especially in light of the ease of treating cataracts.

  2. Seth Martin, MD says:
    October 9, 2013 at 12:57 pm

    I agree with John, this warrants further examination, but is not a game changer. In my view, further studies should try to tease out whether there is a dose response relationship and the outcome measure should be actively ascertained by clinical exam, rather than ICD-9 code based.