Coordinated by Bobby Christensen, O.D., F.A.A.O.

therapeutic insights
Statins and Your Patients
Cholesterol-lowering medication can have visual and other effects; know what to expect.
by Bobby Christensen, O.D., F.A.A.O.

Statins and cholesterol control has been a hot topic lately in Prescriber's Letter, a monthly publication that provides the latest information on new prescribed medications, side effects that physicians are reporting with medications and the latest drug studies summarized into bullet points.

Because primary care optometrists encounter arcus senilis, sclerotic vessels, diabetes and hypertension daily, I want to summarize the latest information on cholesterol guidelines and how statins, which many patients who have the above-mentioned conditions take, affect life expectancy.

Risky business

Experts now recommend more aggressive lipid lowering than they did previously. The opinion is that "lower is better," especially with the risk factors of smoking, family history, hypertension, diabetes, high cholesterol, obesity and age. Here's how researchers define risk levels for potential death or disability from vascular disease caused by high cholesterol.

Low risk. No more than one risk factor; low density lipid (LDL) cholesterol less than 160 mg/dL

Moderate risk. Two or more risk factors; LDL cholesterol less than 130 mg/dL

High risk. Heart disease, diabetes or an equivalent risk; LDL cholesterol goal is 100 mg/dL with encouragement to go to 70 mg/dL

Very high risk. Heart disease plus multiple factors; LDL cholesterol goal is 70 mg/dL.

Every little bit helps

The new guidelines listed in Prescriber's Letter recommend using high enough statin doses to lower LDL cholesterol by 30% to 40% in higher risk patients. If patients lower the LDL cholesterol to below 100 mg/dL, they can effectively reduce atherosclerosis progression. For every 1% decrease in LDL cholesterol, you also reduce the relative risk of a cardiovascular event by 1%.

Meds that multi-task

What's of particular interest is that lowering cholesterol seems to have other benefits, including ones related to eye health. Some of those benefits, listed below, may be due to lowering cholesterol and some are possibly caused by the anti-inflammatory effects when using statins.

Macular degeneration. Statin therapy might reduce the risk and progression of macular degeneration. Better blood flow in the tiny macular vessels may lead to less damage.

Glaucoma. A recent study shows a lower risk of glaucoma for patients using statins and other cholesterol-lowering drugs.

Cancer. New studies indicate that patients takings statins have half the risk of prostate or colon cancer.

Rheumatoid arthritis. Statins may slightly reduce inflammation and the number of swollen joints.

Osteoporosis. There may be a lower risk of fractures in postmenopausal women.

Multiple sclerosis. Early research suggests that statins reduce the number of brain lesions.

Alzheimer's. New studies suggest that statins might slow progression and reduce risk.

Experts recommend against prescribing statins for patients who have the above-mentioned conditions until further studies confirm these early findings.

Dosage fine points

Patients typically take statins in the evening because cholesterol production is greater at night. Lovastatin (Mevacor, Altocor), simvastatin (Zocor) and fluvastatin (Lescol) should be recommended for night dosage. Patients can take atorvastatin (Lipitor), resuvastatin (Crestor) and pravastatin (Pravachol) any time during the day because they have a longer half life.

Do your homework

Some of the latest data have shown that patients who have high cholesterol treated early and aggressively can survive for a decade longer than patients who aren't treated. From an ocular perspective, better circulation in the eye can reduce the risk of vascular-related disease.

Statins appear to provide unexpected benefits due to their as yet unexplained anti-inflammatory potential. Much is still speculation regarding the true secondary benefits of statins outside the realm of cholesterol reduction. As primary care optometric physicians, we need to be aware of how these drugs may affect the visual system and the patient as a whole.

Dr. Christensen has a partnership practice in Midwest City, Okla. He's a diplomate in the Cornea and Contact Lens Section of the American Academy of Optometry. He's also a member of National Academies of Practice.