Effect of cholesterol lowering with statins or proprotein convertase subtilisin/kexin type 9 antibodies on cataracts: A meta-analysis.

BACKGROUND: It is not known whether statins or proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies are associated with cataract and whether very low achieved low-density lipoprotein cholesterol (LDL-C) lowering may cause cataract.

OBJECTIVE: To examine two questions: whether statins and/or PCSK9 antibodies cause or prevent cataracts and whether very low LDL-C is associated with increased risk of cataract.

METHODS: Systematic searches of PubMed, ClinicalTrials.gov, Web of Science, The Cochrane Library, and an Federal Drug Administration report were used to perform random effects meta-analyses on the relationship of statins and/or PCSK9 antibodies with cataract. These meta-analyses were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS: Prespecified analyses indicated no significant effect of statins or PCSK9 antibodies (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.83-1.17, P = .8889) or differences between the effects of statins (OR 0.89, 95% CI 0.66-1.19, P = .4349) and PCSK9 antibodies (OR 1.04, 95% CI 0.85-1.28, P = .7042) on the development of cataract. Also, there was no significant effect of LDL-C lowering to different levels with respect to cataract (OR 1.06, 95% CI 0.92-1.22, P = .4317). Meta-regression of the log OR for cataract vs LDL-C during treatment did not show a statistically significant relationship (P for slope = .3972).

CONCLUSION: There was no significant effect of cholesterol lowering with statins or PCSK9 antibodies or differences between these two medication classes in causing or preventing cataracts. However, it is difficult to make definitive statements regarding PCSK9 antibodies because there is no long-term experience with these agents. Very low LDL-C was not associated with higher risk of cataract.