Cholesterol-Lowering Drugs Linked To Increased Risk Of Cataracts: Ten Things You Need To Know

A research study recently published in the journal JAMA Ophthalmology reports a 2 to 40% greater risk of developing cataracts for people who take statin medications to lower cholesterol.

Since cataracts are relatively easy to treat and heart disease is often fatal, most doctors believe that the protective effect of the medications outweighs the risk to sight, but here are answers to 10 questions your cardiologist may not take time to answer for you.

1. What do the researchers mean by "cataract?"

Typically, if you are the person who has the cataract, the thickening of the lens of your eye will be described as:

• Incipient, meaning the ophthalmologist can see it when he or she looks at your eyes in the slit lamp examination but it's not causing significant loss of sight,

• Immature, meaning the cataract is causing loss of sight but the person who has the cataract can still read letters on the eye chart corresponding to 20/200 vision, or

• Mature, meaning the cataract has caused so much loss of sight that it is no longer possible to read the letters on the chart corresponding to 20/200 vision.

This study looked at the incidence of "mature" cataracts in 33,513 men and women aged 30 to 85 over a period of 5 years.

2. What do the researchers mean by "statin?"

The research study considered all statin drugs that would be dispensed by the VA hospitals and clinics in the United States (the study was conducted primarily with male military and ex-military members who lived in the vicinity of San Antonio, Texas).

However, the researchers did separate analyses looking at:

• Anyone in the study had ever taken a statin medication for 90 days or more, and

• People who had taken statins for 2 years, people who had taken statins for 4 years, and people who had taken statins for 6 years or more.

3. How much worse is the risk of developing cataracts if I go on statins?

But it's helpful to put that in perspective. Before statin drugs were commonly prescribed, about 65% of people over the age of 75 developed cataracts. If you live long enough, in other words, you'll probably have about a 2 in 3 chance of getting cataracts. If you take statin drugs for several years, your risk is probably going to be a 3 in 4 chance, or slightly higher chance, of developing cataracts.

4. So, if I'm not retirement age, I am not at risk for cataracts?

Press releases for the study didn't say, but the Wilmer Eye Institute reported in 2004 that 17% of Americans over the age of 40 have a cataract in at least one eye, and 6% of people 40 and older are have at least one eye that is "pseudophakic," that is, with an implanted lens. Your risk for cataracts before the age of 60, however, is usually due to injury rather than progressive disease.

5. Is surgery the only treatment for cataracts?

At this time, surgical removal of cataracts and implantation of a lens is the only medical treatment for cataracts. There is a pharmaceutical grade herbal formula made in Japan called hochu-ekki-to that greatly reduces the risk of developing cataracts, but it has to be taken for 15 years or more to have that benefit.

But Haven't Some Studies Said Statins Actually Protect Against Cataracts?

As is often the case, the scientists can't seem to quite make up their minds on the subject of statin medications and cataracts.

6. But haven't some researchers found that cholesterol-lowering statins actually reduce the risk of developing cataracts?

There have been some studies that suggest that cholesterol-lowering drugs reduce the risk of cataracts in younger people, younger in this case being "under 50 years old." The reason that taking a statin drug when you are younger would actually lower your risk of developing a cataract is that, in addition to lowering cholesterol levels, statins reduce inflammation.

In younger people, cataracts are most likely to form when the lens of the eye is scratched or punched or burns. Scar tissue in the lens forms in reaction to inflammation. Statins reduce inflammation, so they may actually protect against cataracts in younger people.

In older people, lower levels of LDL are associated with higher rates of cataracts. Some people simply have naturally lower cholesterol levels. It may be that in older people, LDL is needed as fuel for the white blood cells that clear out old tissue so new tissue can replace it. If there isn't enough LDL in the eye, the old tissue accumulates and clouds the lens. But the fact is, researchers don't really know for sure.

7. If my HDL (good) cholesterol goes up, does that counteract the effects of my LDL (bad) cholesterol going down?

Lower LDL cholesterol has been found to be linked to higher rates of cataracts, but higher HDL cholesterol hasn't been found to have an effect.

8. So if I develop a cataract, will my doctor take me off statins?

Probably not. Probably you will just get a referral to see the ophthalmologist for an assessment of your need for surgery.

You get to go home the same day and you probably will have restored vision the next day. About 95% of cataract operations are successful.

However, if you have glaucoma, or if you have to take steroids, then the doctor may advise you on other ways to control your cholesterol levels.

9. Should I just quit statins if my vision gets blurry?

No. Make these decisions with your doctor. Blurry vision can result from many conditions other than just cataract.

10. I don't want to get cataracts. I don't want to have a heart attack, either. What can I do?

There are some things you can do to protect your eyes and reduce the risk you will develop cataracts, or at least slow the process down.

• Wear UV-protective sunglasses or UV-blocking eyeglasses when you go outdoors. It's important not to use sunglasses that aren't UV-protective, since your eyes will actually open wider and admit more of the tissue-damaging UV light when you wear sunshades than when you don't.

• If you are diabetic, keep your blood sugar levels down all the time. High blood sugar levels cause proteins in the lens of the eye to cross-link and form scar tissue.

• Don't smoke. And if you do smoke, make sure to eat some colored vegetables every other day or so. As little as one serving of carrots a month can make a difference in your overall health, and 1 or 2 servings of colorful vegetables high in carotenoids (beta-carotene and related compounds), although not taking supplements, is generally helpful for smokers and non-smokers alike.

The findings of this US study are consistent with another large-scale study just completed in Taiwan. If you take statins, you probably will have an increased risk of cataracts, especially if you are over 65. But whether or not that's worth the risk is something you need to decide with the best information your doctor can provide.