Original Investigation | Clinical Sciences

Association of Statin Use With Cataracts:  A Propensity Score–Matched Analysis

Jessica Leuschen, MD1,2; Eric M. Mortensen, MD, MSc3,4; Christopher R. Frei, PharmD, MS5,6; Eva A. Mansi, FRCS8; Vasudha Panday, MD1,2,7; Ishak Mansi, MD3,4
[+] Author Affiliations
1Wilford Hall Ambulatory Surgery Center, San Antonio, Texas
2San Antonio Military Medical Center, San Antonio, Texas
3VA North Texas Health Care System, Dallas, Texas
4University of Texas Southwestern Medical Center, Dallas
5College of Pharmacy, The University of Texas at Austin
6Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center, San Antonio, Texas
7Uniformed Services University of the Health Sciences, University of Texas Health Science Center, San Antonio, Texas
8Ramad Hospital, Alexandria, Egypt
JAMA Ophthalmol. 2013;131(11):1427-1434. doi:10.1001/jamaophthalmol.2013.4575.
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Importance  Cataracts are a main cause of low vision; with the growing elderly population, the incidence of cataracts is likely to increase. Investigators have previously hypothesized that statin antioxidant effects may slow the natural aging process of the lens.

Objective  To compare the risks for development of cataracts between statin users and nonusers.

Design  A propensity score–matched cohort analysis using retrospective data from October 1, 2003, to March 1, 2010. A propensity score–matched cohort of statin users and nonusers was created using 44 variables.

Setting  Database of a military health care system.

Participants  Based on medication fills during fiscal year 2005, patients were divided into 2 groups: (1) statin users (received at least a 90-day supply of statin) and (2) nonusers (never received a statin throughout the study). Among 46 249 patients meeting study criteria, we identified 13 626 statin users and 32 623 nonusers.

Exposure  Use of statin therapy for more than 90 days.

Main Outcomes and Measures  Primary analysis examined the risks for cataract in the propensity score–matched cohort. Secondary analyses examined the risks for cataract in patients with no comorbidities according to the Charlson Comorbidity Index (patients with no Charlson comorbidity). A sensitivity analysis was conducted to repeat the secondary analysis in patients taking statins for durations of 2, 4, and 6 years.

Results  For our primary analysis, we matched 6972 pairs of statin users and nonusers. The risk for cataract was higher among statin users in comparison with nonusers in the propensity score–matched cohort (odds ratio, 1.09; 95% CI, 1.02-1.17). In secondary analyses, after adjusting for identified confounders, the incidence of cataract was higher in statin users in comparison with nonusers (odds ratio, 1.27; 95% CI, 1.15-1.40). Sensitivity analysis confirmed this relationship.

Conclusions and Relevance  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.

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