Are self-reported elevated cholesterol level and statin use associated with risk of primary open-angle glaucoma?
In this population-based cohort study of 886 incident cases of primary open-angle glaucoma from 136 782 participants who contributed person-time for up to 15 or more years and provided repeated updated data on statin use and cholesterol levels, 5 or more years of statin use was associated with a 21% lower risk of primary open-angle glaucoma, while every 20-mg/dL increase in total serum cholesterol was associated with a 7% increase in risk of primary open-angle glaucoma.
Statin use, which is highly prevalent among older persons at risk for primary open-angle glaucoma, was associated with a lower risk of primary open-angle glaucoma.
The use of statins (hydroxymethylglutaryl coenzyme A inhibitors) has been associated with a lower risk of primary open-angle glaucoma (POAG); however, results have been conflicting, and little is known about the association between high cholesterol levels and POAG.
To assess the association of elevated cholesterol levels and statin use with incident POAG.
Design, Setting, and Participants
This study used data collected biennially from participants aged 40 years or older who were free of glaucoma and reported eye examinations, within 3 population-based cohorts: the Nurses’ Health Study (N = 50 710; followed up from 2000 to 2014), the Nurses’ Health Study 2 (N = 62 992; 1999-2015), and the Health Professionals Follow-up Study (N = 23 080; 2000-2014). Incident cases of POAG were confirmed by medical record review. The analyses were performed in January 2019.
Biennially updated self-reported information on elevated cholesterol level status, serum cholesterol levels, and duration of statin use.
Main Outcomes and Measures
Multivariable-adjusted relative risks (RRs) and 95% CIs were estimated using Cox proportional hazards regression models on pooled data, with stratification by cohort.
Among the 136 782 participants in the 3 cohorts (113 702 women and 23 080 men), 886 incident cases of POAG were identified. Every 20-mg/dL increase in total serum cholesterol was associated with a 7% increase in risk of POAG (RR, 1.07 [95% CI, 1.02-1.11]; P = .004). Any self-reported history of elevated cholesterol was also associated with a higher risk of POAG (RR, 1.17 [95% CI, 1.00-1.37]). A history of any statin use was associated with a 15% lower risk of POAG (RR, 0.85 [95% CI, 0.73-0.99]). Use of statins for 5 or more years vs never use of statins was associated with a 21% lower risk of POAG (RR, 0.79 [95% CI, 0.65-0.97]; P = .02 for linear trend). The association between use of statins for 5 or more years vs never use of statins and risk of POAG was more inverse in those who were older (≥65 years: RR, 0.70 [95% CI, 0.56-0.87] vs <65 years: RR, 1.05 [95% CI, 0.68-1.63]; P = .01 for interaction).
Conclusions and Relevance
Among adults aged 40 years or older, higher serum cholesterol levels were associated with higher risk of POAG, while 5 or more years of statin use compared with never use of statins was associated with a lower risk of POAG.
Kang JH, Boumenna T, Stein JD, et al. Association of Statin Use and High Serum Cholesterol Levels With Risk of Primary Open-Angle Glaucoma. JAMA Ophthalmol. 2019;137(7):756–765. doi:10.1001/jamaophthalmol.2019.0900
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