Macular Degeneration Risk Greater for Elderly Aspirin Users
Statins Cut Glaucoma Risk in Older Eyes
Longer duration of statin use was linked to further decreased risk of the disease.
By Nancy Walsh, MedPage Today
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TUESDAY, Oct. 2, 2012 (MedPage Today) —Older individuals who take statins are at decreased risk for developing open-angle glaucoma or for having progression of the disease, a large retrospective study found.
After adjustment for other medical and ocular comorbidities, every month of statin use decreased the risk for developing open-angle glaucoma by 0.3 percent, according to Joshua D. Stein, MD, and colleagues from the University of Michigan in Ann Arbor.
Statin therapy also lowered the chance that a patient with suspected glaucoma would progress to confirmed open-angle glaucoma by 0.4 percent for each month of use, the researchers reported online inOphthalmology.
It has become increasingly clear that statins have benefits beyond lowering cholesterol, as protective effects have been seen in disorders affecting the central nervous system such as multiple sclerosis and Alzheimer's disease.
Because the damage caused by open-angle glaucoma is primarily to the retinal and optic nerves, Stein and colleagues hypothesized that statins might also have preventive effects against glaucoma.
So they examined the medical records of 524,109 patients with elevated lipids enrolled in a national managed care network.
Participants' mean age was 68, slightly more than half were women, and the majority were white.
A total of 60.3 percent of the patients with dyslipidemia had received one or more prescriptions for a statin during a mean of 4.3 years of enrollment in the network.
An additional 4 percent had been given a prescription for a nonstatin lipid-lowering agent, and the remainder had not used anti-cholesterol medications.
The statins most commonly prescribed were simvastatin (Zocor) and atorvastatin (Lipitor).
Overall, 10,266 patients were diagnosed with glaucoma during the study period.
Longer duration of statin use was associated with greater decrease in glaucoma risk. After 12 months of statin use and adjustment for possible confounders, the risk had decreased by 4 percent (HR 0.960, 95 percent CI 0.933 to 0.988), the researchers reported.
Moreover, continuous use for 2 years led to an 8 percent decrease, they found.
After 2 years of enrollment in the plan, 6,934 individuals who had been diagnosed with possible glaucoma had progressed to definite glaucoma.
One year of statin treatment also reduced the likelihood of progression by 5 percent, while 2 years of treatment decreased the risk for progression by 9 percent.
After 2 years, 11,420 individuals had been given a new prescription for a medication to lower intraocular pressure. For each month of statin exposure, the risk for having been given a glaucoma medication fell by 0.4 percent.
A year of use led to a 5 percent decrease in the likelihood of having been given a medication, while 2 years of use led to a decrease of 10 percent.
Nonstatin lipid-lowering treatment also was associated with an 0.6 percent monthly decrease in risk for having been given a medication for glaucoma, but the use of these agents did not influence patients' risk for glaucoma diagnosis or progression.
The observation that nonstatin drugs did not significantly lower these risks "suggests that statins may have an effect on the development of glaucoma that is independent of their cholesterol-lowering properties," the researchers stated.
Possible mechanisms by which statin use could influence risk of glaucoma include upregulation of endothelial nitric oxide synthase, which could increase ocular blood flow, and neuroprotection of ganglion cells in the retina.
The need for surgery in advanced disease was not attenuated by treatment with statins, which suggests that the drugs may be most useful in early disease, according to the authors.
Limitations of the study include the use of administrative data and the unavailability of important clinical data such as intraocular pressures and laboratory lipid values.
In addition, whether the glaucoma preventive effects seen in this cohort of patients with hyperlipidemia would extend to individuals with normal lipid profiles is unknown.
"Given the mounting evidence of statin protection against [open-angle glaucoma], including both basic science and observational clinical studies, an interventional prospective study might provide additional insights into the role of statins in the prevention of early [open angle glaucoma]," they concluded.
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