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Shaza Al-Holou, William R Tucker, Elvira Agron, Traci E Clemons, Emily Y Chew, AREDS2 Research Group; The Association of Statin Use with Cataract Progression Using Propensity Matching in the Age-Related Eye Disease Study 2 (AREDS2). Invest. Ophthalmol. Vis. Sci. 2014;55(13):1675.
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To examine the potential association of statin use with the progression of cataract.
AREDS2 was a 5 year prospective randomized clinical trial of nutritional supplements for the treatment of age-related macular degeneration and lens opacities. Masked graders at the reading center evaluated annual red reflex fundus photographs for incident pseudophakia/aphakia, cortical and posterior subcapsular (PSC) lens opacities. Nuclear cataract status, evaluated clinically at each study visit, demonstrated high variability, thus these data were not used. History of cataract surgery was obtained during the 6 month telephone calls. Study participants self-reported concurrent use of statins. Covariates potentially associated with the use of statins were analyzed in a logistic regression to estimate propensity scores. Statin and non-statin users were paired based on their propensity scores using Greedy Matching Techniques in order to balance the covariates. Cox regression was performed to estimate the effect of statin use on the progression of cataract in either eye.
Of the 4203 AREDS2 participants (age range 50-85 years), 2771 were phakic at baseline with available data for analysis. Covariates in logistic regression included age, sex, smoking status, aspirin use, diabetes, hypertension, history of heart disease including angina, and history of stroke. Matching statin users and non-users by their propensity score resulted in 904 pairs. Statin users had an increased risk of incident cataract surgery [hazard ratio (HR), 3.28; 95% confidence interval (CI), 1.74-6.18]. This persisted after adjusting for age and sex [HR 2.15, 95%; CI 1.08-4.32]. Further subgroup Cox regression analysis based on sex revealed female but not male participants had a statistically significantly increased risk of both incident cataract surgery and progression of cortical or PSC lens opacity. The results of Cox regression are shown in Table 1.
Statin use was associated with an increased risk of: 1) incident cataract surgery, a likely surrogate for nuclear cataract, and of 2) cortical and 3) PSC lens opacity progression. The results showed a consistent statistically significant association in women for cataract surgery and the 2 cataract types.
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