In a large study published on May 2, 2019, in JAMA Opthalmology, scientists determined that long-term use of statins may offer protection against developing glaucoma, a condition that increases pressure within the eyeball and is the leading cause of blindness. “Previous studies linking cholesterol or cholesterol-lowering drugs to glaucoma risk have shown inconsistent findings, but our study suggests possible protective associations beyond cardiovascular conditions for long-term statin use,” says Jae Hee Kang, ScD, lead study author and an assistant professor of medicine in the Channing Division of Network Medicine at Brigham and Women’s Hospital in Boston. Dr. Kang and her team tracked 136,782 individuals ages 40 and older, who all started the study free of this eye condition. Participants provided details on their serum cholesterol levels and statin use by completing a questionnaire. Over 15 years, between 2000 and 2015, 886 developed primary open-angle glaucoma, which is the most common form of the disease and affects about one percent of all Americans. Study authors observed that for every 20 milligrams per deciliter (mg/dL) increase in total serum cholesterol, glaucoma risk climbed by 7 percent. On the other hand, five or more years of statin use was associated with a 21 percent drop in glaucoma risk. “This indicates that statins may have a potential role in mitigating glaucoma pathogenesis [development of the disease],” says Mark Fromer, MD, an ophthalmologist with Lenox Hill Hospital in New York City, who was not involved with the study. “The statins may also have a neuroprotective mechanism.” The results back up other research, such as a study published in March 2019 in the journal Investigative Opthalmology & Visual Science, showing that hyperlipidemia (high blood cholesterol) is connected to the eye disease. “Glaucoma’s relation with high cholesterol may be related to impaired blood flow to the optic nerve or to the exacerbation of neurodegenerative processes with aging,” says Kang. Dr. Fromer adds that statins may also increase aqueous [water] outflow, which would decrease pressure inside the eye. RELATED: How Is Glaucoma Treated?
A Reason to Stay on Statins and Get Your Eyes Checked
The American Heart Association endorses statins as the only cholesterol-lowering drug class that has been directly associated with a reduction in the risk of heart attack or stroke. Cholesterol is a waxy, fat-like substance in the body that comes in two types. The “good” one, or high-density lipoproteins (HDL), helps remove fats from the body, while the “bad” type, or low-density lipoproteins (LDL), can contribute to fat buildup and clog the arteries. Statins work by blocking a liver enzyme that is essential for creating the bad cholesterol. Some of the most commonly prescribed statins are atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), pitavastatin (Livalo), simvastatin (Zocor), and rosuvastatin (Crestor). “Based on these results, I would advise patients to keep your cholesterol at normal levels and use your statins regularly if prescribed by a doctor,” says Fromer. The researchers underscore that they cannot make recommendations on how to prevent glaucoma based solely on these findings. Kang warns individuals with family histories of glaucoma against using statins or other cholesterol medication strictly for glaucoma prevention. “We do recommend, however, that those over the age of 40 get the recommended regular eye exams to help detect glaucoma as early as possible, as it is an insidious chronic disease that can lead to blindness,” says Kang. The authors point out that their results were limited by the fact that all information analyzed was self-reported and the study population was not diverse — more than 90 percent of the participants were white and they were all healthcare professionals. Kang and her team stress that more research in this area is needed, and in fact, some studies have produced conflicting results. A report published in November 2015 in the journal Medicine, for example, found that the incidence of glaucoma rose with an increase in statin dosage. “A definitive means of assessing the role of statins for glaucoma prevention would be to conduct a randomized clinical trial,” says Kang. “As high cholesterol and statin use have been associated with other neurodegenerative diseases, the interrelationships between cholesterol, glaucoma, and these outcomes is also fertile ground for further scientific inquiry.”
