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.

Alexios S Antonopoulos, Marios Margaritis, Regent Lee, Keith Channon, and Charalambos Antoniades Statins as Anti-Inflammatory Agents in Atherogenesis: Molecular Mechanisms and Lessons from the Recent Clinical Trials Curr Pharm Des. 2012 April; 18(11): 1519–153

Babizhayev MA, Deyev AI, Yermakova VN, Brikman IV, Bours J. Lipid peroxidation and cataracts: N-acetylcarnosine as a therapeutic tool to manage age-related cataracts in human and in canine eyes. Drugs R D. 2004;5(3):125-39.

Chodick G, Heymann AD, Flash S, Kokia E, Shalev V. Persistence with statins and incident cataract: a population-based historical cohort study. Ann Epidemiol. 2010 Feb;20(2):136-42.

Chylack LT Jr, Mantell G, Wolfe JK, Friend J, Rosner B. Lovastatin and the human lens; results of a two year study. The MSDRL Study Group. Optom Vis Sci. 1993 Nov;70(11):937-43.

de Vries AC, Vermeer MA, Bloemendal H, Cohen LH. Pravastatin and simvastatin differently inhibit cholesterol biosynthesis in human lens. Invest Ophthalmol Vis Sci. 1993 Feb;34(2):377-84.

Duindam HJ, Vrensen GF, Otto C, Puppels GJ, Greve J. New approach to assess the cholesterol distribution in the eye lens: confocal Raman microspectroscopy and filipin cytochemistry. J Lipid Res. 1995 May;36(5):1139-46.

Gavin J Blake and Paul M R Are statins anti-inflammatory? Curr Control Trials Cardiovasc Med. 2000; 1(3): 161–165.

Girao H, Mota C, Pereira Cholesterol may act as an antioxidant in lens membranes. Curr Eye Res. 1999 Jun;18(6):448-54.

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 May 20;340:c2197. doi: 10.1136/bmj.c2197.

Jensen JD, Hurley RJ. Conflicting stories about public scientific controversies: Effects of news convergence and divergence on scientists' credibility. Public Underst Sci. 2012 Aug;21(6):689-704.

Lai CL, Shau WY, Chang CH, Chen MF, Lai MS. Statin Use and Cataract Surgery: A Nationwide Retrospective Cohort Study in Elderly Ethnic Chinese Patients. Drug Saf. 2013 Jun 15.

Lei JY, Yao K. Research relating the use of systematic drug and cataracts. Zhonghua Yan Ke Za Zhi. 2013 May;49(5):468-71.

Leuschen J, Mortensen EM, Frei CR, Mansi EA, Panday V, Mansi I. Association of Statin Use With Cataracts: A Propensity Score-Matched Analysis. JAMA Ophthalmol. 2013 Sep 19.

Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA, Schulman J. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006 Dec 19;145(12):880-6.

Mansi IA, Mortensen EM, Pugh MJ, Wegner M, Frei CR. Incidence of musculoskeletal and neoplastic diseases in patients on statin therapy: results of a retrospective cohort analysis. Am J Med Sci. 2013 May;345(5):343-8.

Mansi I, Frei CR, Pugh MJ, Makris U, Mortensen EM. Statins and musculoskeletal conditions, arthropathies, and injuries. JAMA Intern Med. 2013 Jul 22;173(14):1-10.

Jeanne Mitchell, MS; Richard J. Cenedella, PhD Human Lens Cholesterol Concentrations in Patients Who Used Lovastatin or Simvastatin Arch Ophthalmol. 1999;117(5):653-657.

Schlienger RG, Haefeli WE, Jick H, Meier CR. Risk of cataract in patients treated with statins. Arch Intern Med. 2001 Sep 10;161(16):2021-6.

Andrew M. Seaman Statin use tied to cataract development: study NEW YORK | Thu Sep 19, 2013 4:03pm EDT

*These statements have not been evaluated by the FDA. These products are not intended to treat, diagnose, cure, or prevent any disease.