AMSTERDAM – Contrary to concerns that statins may increase cataract risk, statin use was significantly associated with a 19% lower risk of cataracts – and the risk fell to 51% when statins were prescribed to younger people over a longer period, according to a new meta-analysis.
"The bottom line is that statins prevent cataracts," said Dr. John B. Kostis during a presentation at the annual congress of the European Society of Cardiology. "But the bottom line is: Don’t be scared of cataracts when prescribing statins."
The concern about statins’ cataractogenicity arose in the 1980s, when the Food and Drug Administration approved lovastatin with the precaution that patients should be examined with a slit-lamp before and during treatment.
Dr.John B. Kostis
The agency removed that recommendation in 1991, but studies such as the recent Waterloo Eye Study continued to show an association between statin use and an increased risk of cataracts.
Dr. Kostis and his colleagues at Robert Wood Johnson Medical School, New Brunswick, N.J., included 13 studies in their meta-analysis, which included a total of 2.4 million individuals and 25,658 cataract cases.
The average number of patients per study was 171,689 (median study size, 2,746). Dr. Kostis added that two studies were very large and were excluded in the sensitivity analyses. The average patient age was 61 years, and the average duration of statin treatment was 54 months.
Results showed that there was nearly a 20% decrease in the rate of cataracts among patients who were treated with statins, compared with those who were not (odds ratio, 0.81; P = .0009).
The statins’ effect was also significant in studies that examined clinical cataracts (OR, 0.81; P = .0022), although the trend was not significant in studies examining opacities detected by ophthalmologists (OR, 0.81; P = .2106)
There was also a 1.4% absolute risk reduction (P less than .0001), demonstrating that 71 individuals needed to be treated with statins to prevent one case of cataracts, Dr. Kostis said.
Meanwhile, patients who began statin therapy in their 40s had a 51% lower chance of cataracts (OR, 0.49), compared with those who began the treatment in their 70s and probably already had cataracts (OR, 1.03, or no risk reduction), he said.
"It is possible that the two processes (aging and statins) work in parallel or interactively," Dr. Kostis said in a news release.
In addition, there was a 46% reduction in the risk of cataracts when patients were treated with statins for as long as 14 years (OR, 0.54), compared with a 10% risk reduction among those who were treated for only 6 months (OR, 0.90).
Gender did not play a role in the findings.
The meta-analysis had several limitations. Each of the studies had a different design, and the randomized clinical trials didn’t have cataracts as an endpoint. Also, the certainty of exposure to statins in observational studies is imprecise, and there is the possibility of reporting and publication bias, Dr. Kostis noted.
The strength of the meta-analysis was in the consistency of the statins’ effect when it was analyzed from various aspects, he said. In addition, all published reports on the topic were included in the analysis. Moreover, the effect of statins in preventing cataracts was significantly more pronounced for the hard endpoint of cataract extractions.
A large, randomized clinical trial could put the uncertainty to rest, noted Dr. Kim Allan Williams Sr., chair of cardiology at Wayne State University, Detroit. But the findings from this analysis were reassuring, added Dr. Williams, who was not involved in the meta-analysis.
Dr. Kostis had no disclosures. Dr. Williams has received consultant fees/honoraria from Astellas Healthcare.
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