COMMENTARY

Do Statins Protect Against Glaucoma?

Shuchi B. Patel, MD

Disclosures

May 13, 2013

The Relationship Between Statin Use and Open-Angle Glaucoma

Stein JD, Newman-Casey PA, Talwar N, Nan B, Richards JE, Musch DC
Ophthalmology. 2012;119:2074-2081

Study Summary

The idea that statins are protective in patients with central nervous system diseases led to a hypothesis that they might be beneficial in patients with open-angle glaucoma (OAG), because glaucoma is an optic neuropathy. Stein and colleagues used a nationwide healthcare claims database containing detailed medical records for more than 500,000 patients with hyperlipidemia to determine whether an association exists between statin use and the development of OAG, the conversion from "glaucoma suspect" to OAG, or the need for medical or surgical therapy for OAG.

Inclusion criteria were met by 524,109 patients with hyperlipidemia, of whom 316,182 had a prescription for statins filled according to pharmacy records. The mean length of time that participants were taking statins was 800 ± 621 days (range, 1-3266 days), and 96% took statins for longer than 30 days. Multivariable models were adjusted for age, sex, race, education level, household net worth, region of residence at the time of medical plan enrollment, time-dependent use of nonstatin cholesterol-lowering medications, ocular comorbid conditions (cataract, pseudophakia or aphakia, macular degeneration, diabetic retinopathy), medical comorbid conditions (diabetes mellitus, systemic hypertension, obesity, systemic hypotension, sleep apnea, migraine), and the Charlson Comorbidity Index (a measure of overall health).

Results showed that the risk for OAG decreased 0.3% (adjusted hazard ratio [HR], 0.997; 95% confidence interval [CI], 0.994-0.999) for every additional month of statin use. Individuals with hyperlipidemia who took statins continuously for 2 years had an 8% (adjusted HR, 0.922; 95% CI, 0.870-0.976) lower OAG risk compared with those who received no statin therapy. The risk for progressing from a diagnosis of "glaucoma suspect" to OAG decreased 0.4% (adjusted HR, 0.996; 95% CI, 0.993-0.999) for every additional month of statin exposure. Persons who took statins continuously for 2 years had a 9% (adjusted HR, 0.907; 95% CI, 0.846-0.973) lower risk for progressing from "glaucoma suspect" to OAG compared with those who received no statin therapy. The risk for requiring medical treatment for OAG decreased 0.4% (adjusted HR, 0.996; 95% CI, 0.993-0.998) for every additional month of statin exposure. No differences in need for glaucoma surgery were found among patients with OAG who were or were not taking statins (adjusted HR, 1.002; 95% CI, 0.994-1.010).

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