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Canadian Journal of Cardiology

Statin Use and Risk for Cataract: A Nested Case-Control Study of 2 Populations in Canada and the United States

      Abstract

      Background

      In current literature the association between statin use and cataracts is inconsistent and controversial. We sought to further examine the effect of statin use on the risk of cataract and need for surgical intervention in 2 North American populations.

      Methods

      This retrospective nested case-control study derived data from the British Columbia (BC) Ministry of Health databases from 2000-2007 and the IMS LifeLink database from 2001-2011 to form 2 patient cohorts. The BC cohort was comprised of female and male patients; 162,501 patients were matched with 650,004 control subjects. The IMS LifeLink cohort was comprised of male patients aged 40-85 years; 45,065 patients were matched with 450,650 control subjects. Patients with statin use for > 1 year before the initial ophthalmology visit were identified. Diagnosis and surgical management of cataract were followed. Conditional logistic regression models were used to analyze data.

      Results

      For the BC cohort, the crude rate ratio (RR) for use of any statin was 1.30, and the adjusted RR was 1.27 (95% confidence interval, 1.24-1.30). The adjusted RRs for each individual statin were all statistically significant. For the IMS LifeLink cohort, the crude RR for use of any statin was 1.13, and the adjusted RR was 1.07 (95% confidence interval, 1.04-1.10).

      Conclusions

      This study demonstrates that statin use is significantly associated with cataract requiring surgical intervention. This relationship was consistent in both North American cohorts. Further assessment of this relationship is recommended, especially because of increased statin use and the importance of acceptable vision in old age when cardiovascular disease is common.

      Résumé

      Introduction

      Dans la littérature actuelle, le lien entre l'utilisation des statines et les cataractes est contradictoire et controversé. Nous avons cherché à examiner davantage l'effet de l'utilisation des statines sur le risque de cataractes et la nécessité de l'intervention chirurgicale dans 2 populations nord-américaines.

      Méthodes

      Les données de cette étude de type cas-témoins imbriquée dans une cohorte rétrospective provenaient des bases de données du ministère de la Santé de la Colombie-Britannique (C.-B.) de 2000 à 2007 et de la base de données du IMS LifeLink de 2001 à 2011 pour former 2 cohortes de patients. La cohorte de la C.-B. comprenait des patients de sexe féminin et de sexe masculin; 162 501 patients ont été appariés à 650 004 témoins. La cohorte de la IMS LifeLink comprenait des hommes de 40 à 85 ans; 45 065 patients ont été appariés à 450 650 témoins. Nous avons déterminé les patients qui utilisaient les statines depuis > 1 an avant la visite initiale en ophtalmologie. Nous avons fait le suivi du diagnostic et de la prise en charge chirurgicale des cataractes. Nous avons utilisé des modèles de régression logistique conditionnelle pour analyser les données.

      Résultats

      En ce qui concerne la cohorte de la C.-B., le taux brut (TB) de l'utilisation de toute statine était de 1,30 et le TB ajusté était de 1,27 (intervalle de confiance à 95 %, 1,24-1,30). Les TB ajustés de chacune des statines étaient tous statistiquement significatifs. Pour ce qui est de la cohorte de la IMS LifeLink, le TB de l'utilisation de toutes les statines était de 1,13 et le TB ajusté était de 1,07 (intervalle de confiance à 95 %, 1,04-1,10).

      Conclusions

      Cette étude démontre que l'utilisation des statines est associée de manière significative à des cataractes nécessitant une intervention chirurgicale. Ce lien était cohérent dans les deux cohortes nord-américaines. D'autres évaluations sur ce lien sont recommandées, particulièrement en raison de l'augmentation de l'utilisation des statines et de l'importance d'avoir une vision acceptable au cours de la vieillesse, soit à cette période où la maladie cardiovasculaire est commune.
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      Linked Article

      • Statins and Cataracts: Reverse Causality?
        Canadian Journal of CardiologyVol. 31Issue 5
        • Preview
          The report of Wise et al.,1 on increased risk of cataracts among patients who receive statins, is burdened by the risk of reverse causality inherent in such observational studies. Perhaps the best known example of this problem is the report from a US Health Cooperative, (see Supplemental Reference S1) that patients taking calcium channel antagonists had a greater risk of myocardial infarction, leading to an enormous tempest in a teapot. This fiasco was finally understood when it became apparent that the patients were receiving calcium channel antagonists for angina.
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