Nidhi Talwar1, David C Musch2, Joshua D Stein3. 1. Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor2Center for Eye Policy and Innovation, University of Michigan, Ann Arbor. 2. Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor2Center for Eye Policy and Innovation, University of Michigan, Ann Arbor3Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor. 3. Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor2Center for Eye Policy and Innovation, University of Michigan, Ann Arbor4Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.
Abstract
IMPORTANCE: There is growing evidence that statins may protect against the development or worsening of open-angle glaucoma (OAG). As researchers plan clinical trials to more definitively study whether statins indeed protect against OAG, it would be helpful to know whether specific daily dosages or types of statin confer a greater protective effect than others. OBJECTIVE: To assess whether the protective effect of statins on the risk of glaucoma varies depending on the daily dosage or type of statin taken. DESIGN, SETTING, AND PARTICIPANTS: Using claims data from January 2001 to December 2009, we observed 25 420 patients with no preexisting glaucoma and quantified exposure to statins and other cholesterol-lowering medications. Using multivariable regression modeling, we assessed the hazard of developing OAG and how it varied by the daily dosage or type of statin and whether any protective effect persists after accounting for baseline low-density lipoprotein level. EXPOSURES: Different daily dosages and types of statins. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for developing OAG with 95% CIs. RESULTS: Of the 25 420 patients who met the eligibility criteria for study inclusion, the mean (SD) age was 66.1 (5.8) years, and 14 112 (55.5%) were female. Additionally, 19 232 patients (84.1%) were white, 1252 (5.5%) were black, and 1558 (6.8%) were Latino. After accounting for baseline low-density lipoprotein levels, persons who filled prescriptions for statins continuously for 2 years had a 21% reduced risk of glaucoma compared with nonusers (adjusted HR, 0.79; 95% CI, 0.66-0.96; P = .02). There was no additional protective effect associated with taking the highest dosage of statins (80 mg) compared with a lower dosage (40 mg) (HR, 1.03; 95% CI, 0.59-1.80; P = .91). The protective effect of the following statins on OAG risk did not differ compared with atorvastatin, an inexpensive generic statin: lovastatin (HR, 1.09; 95% CI, 0.71-1.68; P = .69), cerivastatin (HR, 0.61; 95% CI, 0.09-4.41; P = .63), rosuvastatin (HR, 0.83; 95% CI, 0.48-1.44; P = .51), fluvastatin (HR, 0.89; 95% CI, 0.39-2.02; P = .78), pravastatin (HR, 1.29; 95% CI, 0.93-1.79; P = .13), and simvastatin (HR, 1.03; 95% CI, 0.83-1.29; P = .78). CONCLUSIONS AND RELEVANCE: Even after accounting for baseline low-density lipoprotein level, statin exposure continued to be associated with a reduction in OAG risk. Our study helps inform researchers of a reasonable daily dosage and type of statin to use when designing randomized clinical trials to assess the association between statin use and glaucoma.
IMPORTANCE: There is growing evidence that statins may protect against the development or worsening of open-angle glaucoma (OAG). As researchers plan clinical trials to more definitively study whether statins indeed protect against OAG, it would be helpful to know whether specific daily dosages or types of statin confer a greater protective effect than others. OBJECTIVE: To assess whether the protective effect of statins on the risk of glaucoma varies depending on the daily dosage or type of statin taken. DESIGN, SETTING, AND PARTICIPANTS: Using claims data from January 2001 to December 2009, we observed 25 420 patients with no preexisting glaucoma and quantified exposure to statins and other cholesterol-lowering medications. Using multivariable regression modeling, we assessed the hazard of developing OAG and how it varied by the daily dosage or type of statin and whether any protective effect persists after accounting for baseline low-density lipoprotein level. EXPOSURES: Different daily dosages and types of statins. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for developing OAG with 95% CIs. RESULTS: Of the 25 420 patients who met the eligibility criteria for study inclusion, the mean (SD) age was 66.1 (5.8) years, and 14 112 (55.5%) were female. Additionally, 19 232 patients (84.1%) were white, 1252 (5.5%) were black, and 1558 (6.8%) were Latino. After accounting for baseline low-density lipoprotein levels, persons who filled prescriptions for statins continuously for 2 years had a 21% reduced risk of glaucoma compared with nonusers (adjusted HR, 0.79; 95% CI, 0.66-0.96; P = .02). There was no additional protective effect associated with taking the highest dosage of statins (80 mg) compared with a lower dosage (40 mg) (HR, 1.03; 95% CI, 0.59-1.80; P = .91). The protective effect of the following statins on OAG risk did not differ compared with atorvastatin, an inexpensive generic statin: lovastatin (HR, 1.09; 95% CI, 0.71-1.68; P = .69), cerivastatin (HR, 0.61; 95% CI, 0.09-4.41; P = .63), rosuvastatin (HR, 0.83; 95% CI, 0.48-1.44; P = .51), fluvastatin (HR, 0.89; 95% CI, 0.39-2.02; P = .78), pravastatin (HR, 1.29; 95% CI, 0.93-1.79; P = .13), and simvastatin (HR, 1.03; 95% CI, 0.83-1.29; P = .78). CONCLUSIONS AND RELEVANCE: Even after accounting for baseline low-density lipoprotein level, statin exposure continued to be associated with a reduction in OAG risk. Our study helps inform researchers of a reasonable daily dosage and type of statin to use when designing randomized clinical trials to assess the association between statin use and glaucoma.
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