Seeing Eye To Eye?

The world of conflicting information is still doing well, thanks. In the 1950’s, doctors who smoked, smoked Camels. By the 1990’s, many of those doctors had passed away. A few decades back, headlines announced that black pepper caused cancer. Then, miraculously, it didn’t. Conflicting stories about scientific findings abound, even today, and have been the subject of study in an effort to determine the public’s reaction to information that may be harmful or helpful, depending on context (Jensen, 2012). The association of statin drugs and cataracts is a hot topic of recent vintage. The bottom line is evasive because of…conflicting information. It takes only one contrary comment to upset the apple cart of certainty—just one.

The first FDA-approved HMG-CoA reductase inhibitor, or statin, was lovastatin, introduced in 1987. It was, however, found to cause cataracts in beagles if given at high doses, a term that defies definition.  Naturally produced by red yeast rice, certain Aspergillus fungi, and higher fungi such as oyster mushrooms, lovastatin, better known as Mevacor, removes a required building block for cholesterol biosynthesis. Because cholesterol has never been convicted of causing a heart attack (although often accused), there is much wonder these days why statins were ever invented in the first place, since the list of caveats is extensive. But that’s common to most pharmaceuticals, even over-the-counter. Maybe you’ve never noticed, but some brands of OTC meds are more effective than others at treating whatever malady you choose to control. Cough syrup is a good example. The same applies to statins. Some people respond better to some than to others (deVries, 1993).

To indict an inanimate object requires an absolute relation between two events, processes, objects, properties, facts, or states of affairs, where the second event is a consequence of the first. Does owning a swimming pool eventuate a drowning? Does having a throat mean you’ll choke some day? Will you get a ticket every time you speed? Will taking a statin cause you to get a cataract? If you search hard and long, you’re apt to find as many positive as negative correlations to address the last query. For that matter, the same could be said about any human activity or entailment. If you ponder the situation, you might realize that the longer a person lives, the higher the probability of enduring even a minor adversity, including cataracts. Surprisingly, colonoscopy at middle-age has a ten-time higher risk for adverse effect than other commonly used screening tools (Levin, 2006).

Things we learned yesterday differ from ten years ago because of improved measuring techniques and tools, greater understanding of the states of matter and of biological entities, more-user-friendly applications and state-of-the-art materials. In the early 90’s, there was no accurately measureable difference in cataract progression between users and non-users of statin drugs (Chylack, 1993). Almost two decades later, the sophistication of measuring devices has grown considerably enough to track any changes. Something that has been realized along that timeline is the fact that cholesterol is present in the lens of the eye, where its antioxidant effect contributes to lens transparency (Girao, 1999) (Duindam, 1995). There is reasonable speculation that, since statins lower cholesterol levels, there is an increased risk of lens clouding because statins will interfere with the cells responsible for the beneficial process (Leuschen, 2013). Some researchers think that the absence of cholesterol invites lens proteins to move in and take up cholesterol’s space.

The lens is the only part of the body that gets oxygen without blood vessels. It has neither nerves nor connective tissue. Its capsule is made from collagen; its largest mass, from fibers called laminae. Compared to other parts of the eye, the lens has a low energy demand. If they appear, cataracts make the lens opaque. Some opacities are small and require no attention, while others may be large enough to block vision.  For some of us, the proteins in the lens clump together and cloud a small area. This may be the group of statin users (Lai, 2013). Smoking and diabetes hasten this occurrence, although the environment is not totally excused.  Spreading the blame, however, some reports declare systemic drugs like antidepressants, amiodarone, Tamoxifen and nifedipine (a calcium channel blocker known as Procardia) as causative of cataract onset (Lei, 2013).

The number of available statins has grown since their introduction. Their adverse effects are shared, but some are more intense than others, where fluvastatin (Lescol), for example, causes the greatest liver and kidney dysfunction with chronic use (Hippisley, 2010). With this particular drug, its discontinuation returns the risk of cataract to normal within a year.

On the flip side of the coin, an anti-inflammatory portrait of statins has appeared on the scene. Because the cholesterol model of CVD is increasingly viewed with a jaundiced eye in favor of the inflammation model, statins are being touted as the stars of the anti-inflammatory cavalcade. (Truth be told, some culinary/gustatory compounds are better.)  If inflammation increases the risk of cataracts and if statins are anti-inflammatory, then it may be inferred that statins can help to protect against cataract genesis (Gavin, 2000) (Alexios, 2012) (Chodick, 2010)… unless the statins are inhibited by an antibiotic (Schlienger, 2001).

With all this uncertainty, it might pay to take a closer look at statin therapy and to find an alternative.  The naturally-appearing statin in red yeast rice and the other fungi is surrounded by food factors that prevent adverse effects. After all, a statin drug is a chemical isolated from the synergies of foods. Taking a drug provides no excuse to continue behaviors that prompted the drug in the first place, so lifestyle changes might be considered. Cholesterol levels are believed to be minor considerations in cardiovascular health. Besides, who said levels should be lower than 200? Thirty years ago, it was 250. Be careful of what you eat, dump tobacco, take it easy on the ethanol, wear your shades, get enough antioxidants, and listen to your mother.