Drug Safety

, Volume 36, Issue 10, pp 1017–1024 | Cite as

Statin Use and Cataract Surgery: A Nationwide Retrospective Cohort Study in Elderly Ethnic Chinese Patients

  • Chao-Lun Lai
  • Wen-Yi Shau
  • Chia-Hsuin Chang
  • Ming-Fong Chen
  • Mei-Shu LaiEmail author
Original Research Article



Since a report of lenticular opacities in dogs treated with high dosages of statins, the debate on the relationship between statin therapy and cataracts has not reached a conclusion.


The aim of this study was to evaluate the association between statin therapy and the risk of cataract surgery in an elderly ethnic Chinese population using time-dependent analysis to minimize immortal time bias.


A retrospective cohort study using the Longitudinal Health Insurance Database 2005 randomly sampled from the National Health Insurance Research Database, Taiwan, was conducted. A total of 50,165 adults aged between 65 and 90 years in 1998 without records of statin therapy or diagnosis of cataracts between July 1997 and December 1997 were included in the analysis. The first record of lens extraction within the follow-up period (1998–2009) was set as the study endpoint. A propensity score was derived using a logistic regression model to model the receipt of statin therapy as a function of the baseline characteristics for every subject. We used the time-dependent Cox regression model to test the relative hazard of undergoing cataract surgery between statin users and non-users, while use of statins was treated as a time-dependent variable, controlling for baseline age and individual propensity score.


Of the 50,165 enrolled subjects, 17,670 individuals with an incident lens extraction were identified during a median follow-up of 10.7 years. The incidence of cataract surgery was 49.7/1,000 person-years in the statin-using period compared with 38.5/1,000 person-years in the statin-non-using period. The adjusted hazard ratio of cataract surgery was 1.20 (95 % CI 1.14–1.27; P < 0.001) in statin users compared with statin non-users.


Statin therapy was associated with a modestly increased risk of cataract surgery. We suggest regular checks for lens opacity in statin users.


Statin Cataract Statin Therapy Statin User Lens Opacity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study is based in part on data from the NHIRD provided by the Bureau of National Health Insurance, Department of Health, Taiwan, and managed by National Health Research Institutes, Taiwan. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, Taiwan or National Health Research Institutes, Taiwan.

Authors’ contributions

Conception and design: C-L Lai, W-Y Shau, C-H Chang, M-F Chen, M-S Lai. Acquisition of data: C-L Lai. Analysis and interpretation of the data: C-L Lai. Drafting of the article: C-L Lai. Critical revision of the article for important intellectual content: W-Y Shau, C-H Chang, M-S Lai. Statistical analysis: C-L Lai. Obtaining of funding: M-F Chen, M-S Lai. Administrative, technical, or material support: W-Y Shau, C-H Chang. Supervision: M-F Chen, M-S Lai. Final approval of the article: C-L Lai, W-Y Shau, C-H Chang, M-F Chen, M-S Lai.

Source of funding

This work was supported by Grant 98HP0021 from the Ministry of Education Aiming for the Top University and Elite Research Center Development Plan (MoEATU Plan) in Taiwan.

Conflicts of interest

Chao-Lun Lai, Wen-Yi Shau, Chia-Hsuin Chang, Ming-Fong Chen, and Mei-Shu Lai have no conflicts of interest that are directly relevant to the content of this manuscript.

Supplementary material

40264_2013_76_MOESM1_ESM.doc (94 kb)
Supplementary material 1 (DOC 93 kb)


  1. 1.
    Javitt JC, Wang F, West SK. Blindness due to cataract: epidemiology and prevention. Annu Rev Public Health. 1996;17:159–77.PubMedCrossRefGoogle Scholar
  2. 2.
    West SK, Munoz B, Schein OD, et al. Racial differences in lens opacities: the Salisbury Eye Evaluation (SEE) project. Am J Epidemiol. 1998;148(11):1033–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Cheng CY, Liu JH, Chen SJ, et al. Population-based study on prevalence and risk factors of age-related cataracts in Peitou Taiwan. Chin Med J (Taipei). 2000;63(8):641–8.Google Scholar
  4. 4.
    Tsai SY, Hsu WM, Cheng CY, et al. Epidemiologic study of age-related cataracts among an elderly Chinese population in Shih-Pai Taiwan. Ophthalmology. 2003;110(6):1089–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Charlton-Menys V, Durrington PN. Human cholesterol metabolism and therapeutic molecules. Exp Physiol. 2008;93(1):27–42.PubMedGoogle Scholar
  6. 6.
    Evans M, Roberts A, Davies S, et al. Medical lipid-regulating therapy: current evidence, ongoing trials and future developments. Drugs. 2004;64(11):1181–96.PubMedCrossRefGoogle Scholar
  7. 7.
    Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–78.PubMedCrossRefGoogle Scholar
  8. 8.
    Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.CrossRefGoogle Scholar
  9. 9.
    Brown WV. Safety of statins. Curr Opin Lipidol. 2008;19(6):558–62.PubMedCrossRefGoogle Scholar
  10. 10.
    Kiortsis DN, Filippatos TD, Mikhailidis DP, et al. Statin-associated adverse effects beyond muscle and liver toxicity. Atherosclerosis. 2007;195(1):7–16.PubMedCrossRefGoogle Scholar
  11. 11.
    Gerson RJ, MacDonald JS, Alberts AW, et al. On the etiology of subcapsular lenticular opacities produced in dogs receiving HMG-CoA reductase inhibitors. Exp Eye Res. 1990;50(1):65–78.PubMedCrossRefGoogle Scholar
  12. 12.
    Cenedella RJ. Cholesterol and cataracts. Surv Ophthalmol. 1996;40(4):320–37.PubMedCrossRefGoogle Scholar
  13. 13.
    Laties AM, Shear CL, Lippa EA, et al. Expanded clinical evaluation of lovastatin (EXCEL) study results. II. Assessment of the human lens after 48 weeks of treatment with lovastatin. Am J Cardiol. 1991;67(6):447–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Chylack LT Jr, Mantell G, Wolfe JK, et al. Lovastatin and the human lens; results of a two year study. The MSDRL Study Group. Optom Vis Sci. 1993;70(11):937–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Harris ML, Bron AJ, Brown NA, et al. Absence of effect of simvastatin on the progression of lens opacities in a randomised placebo controlled study. Oxford Cholesterol Study Group. Br J Ophthalmol. 1995;79(11):996–1002.PubMedCrossRefGoogle Scholar
  16. 16.
    Pedersen TR, Berg K, Cook TJ, et al. Safety and tolerability of cholesterol lowering with simvastatin during 5 years in the Scandinavian Simvastatin Survival Study. Arch Intern Med. 1996;156(18):2085–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Schlienger RG, Haefeli WE, Jick H, et al. Risk of cataract in patients treated with statins. Arch Intern Med. 2001;161(16):2021–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Smeeth L, Hubbard R, Fletcher AE. Cataract and the use of statins: a case–control study. QJM. 2003;96(5):337–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Klein BE, Klein R, Lee KE, et al. Statin use and incident nuclear cataract. JAMA. 2006;295(23):2752–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Tan JS, Mitchell P, Rochtchina E, et al. Statin use and the long-term risk of incident cataract: the Blue Mountains Eye Study. Am J Ophthalmol. 2007;143(4):687–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Chodick G, Heymann AD, Flash S, et al. Persistence with statins and incident cataract: a population-based historical cohort study. Ann Epidemiol. 2010;20(2):136–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ. 2010;340:c2197.PubMedCrossRefGoogle Scholar
  23. 23.
    Machan CM, Hrynchak PK, Irving EL. Age-related cataract is associated with type 2 diabetes and statin use. Optom Vis Sci. 2012;89(8):1165–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Fong DS, Poon KY. Recent statin use and cataract surgery. Am J Ophthalmol. 2012;153(2):222–8.PubMedCrossRefGoogle Scholar
  25. 25.
    National Health Insurance Research Database, Taiwan.
  26. 26.
    Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46(10):1075–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRefGoogle Scholar
  28. 28.
    Levesque LE, Hanley JA, Kezouh A, et al. Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ. 2010;340:b5087.PubMedCrossRefGoogle Scholar
  29. 29.
    Suissa S. Immortal time bias in pharmaco-epidemiology. Am J Epidemiol. 2008;167(4):492–9.PubMedCrossRefGoogle Scholar
  30. 30.
    D’Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17(19):2265–81.PubMedCrossRefGoogle Scholar
  31. 31.
    Mayne TJ, Whalen E, Vu A. Annualized was found better than absolute risk reduction in the calculation of number needed to treat in chronic conditions. J Clin Epidemiol. 2006;59(3):217–23.PubMedCrossRefGoogle Scholar
  32. 32.
    Abraham AG, Condon NG, West Gower E. The new epidemiology of cataract. Ophthalmol Clin North Am. 2006;19(4):415–25.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Chao-Lun Lai
    • 1
  • Wen-Yi Shau
    • 2
  • Chia-Hsuin Chang
    • 3
    • 4
  • Ming-Fong Chen
    • 3
  • Mei-Shu Lai
    • 4
    • 5
    Email author
  1. 1.Department of Internal MedicineNational Taiwan University Hospital Hsin-Chu BranchHsin-ChuTaiwan
  2. 2.Division of Health Technology AssessmentCenter for Drug EvaluationTaipeiTaiwan
  3. 3.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Graduate Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
  5. 5.Center for Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and ResearchNational Taiwan University HospitalTaipeiTaiwan

Personalised recommendations