In September, at the annual congress of the European Society of Cardiology, Dr. John B. Kostis of Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J., presented an unpublished meta-analysis of 13 studies, showing that statins had a protective effect on cataracts, especially when they were prescribed to younger people for a longer period of time.
"The bottom line is that statins prevent cataracts," Dr. Kostis said during his presentation at ESC. "But the bottom bottom line is, don’t be scared of cataracts when prescribing statins." (Dr. Kostis said he was submitting a letter to the JAMA editors regarding Dr. Mansi’s study, raising a few questions about the methods and findings.)
Dr. Ishak Mansi
Dr. Mansi and colleagues listed several limitations for the study, including its retrospective observational design. They added that there may be other unidentified baseline confounders, and that successful propensity score matching of individual baseline characteristics doesn’t guarantee that the combined effect of individual difference would have no impact on the outcome of interest. Also, using pharmacy data to identify statin use does not capture statin intake, although most users received the prescription for a mean cumulative duration of 4.5 years, which suggests compliance, they noted.
"The most important message for doctors is that we don’t really know yet the full spectrum of side effects of this very effective group of medications," Dr. Mansi said. "They should prescribe this medication in accordance with the current guidelines, not extrapolate, and not prescribe it lightly. Rather, they should consider the benefit-risk ratio for each individual."
Based on the findings, Dr. Williams said, "Look for statin use in diabetes patients, because it can be associated with faster development of cataract. The other thing is, try and make sure within the patients’ care group, whether it’s in a patient-centered home, in primary care, or even in cardiology, that attention is paid to vision and cataract screening, which can become a routine part of physical exam. Unfortunately, that sounds like that we’re convinced by this study. But I think it’s convincing enough to bring our threshold for screening people with cataracts down a little bit."
The authors suggested that future studies should include regular ophthalmologic examinations and objective assessment tools rather than relying on patient surveys or administrative data.
With the growing elderly population, incidence of cataracts, which comes with a whopping cost of $5 billion annually, is likely to increase, and "understanding and optimizing the modifiable risk factors for developing lens opacities must be a public health priority," Dr. Mansi and colleagues wrote.
Dr. Mansi and Dr. Kostis had no disclosures. Dr. Williams has received consultant fees/honoraria from Astellas Healthcare.
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