Simvastatin and disease stabilization in normal tension glaucoma: a cohort study

Ophthalmology. 2010 Mar;117(3):471-6. doi: 10.1016/j.ophtha.2009.08.016. Epub 2010 Jan 4.

Abstract

Purpose: To investigate whether simvastatin use is associated with visual field (VF) stabilization in patients with normal tension glaucoma (NTG).

Design: Prospective cohort study (ClinicalTrials.gov Identifier: NCT00321386).

Participants: A total of 256 eyes from 256 Chinese subjects with NTG.

Methods: Patients were followed up at 4-month intervals for 36 months for VF progression per Anderson's criteria. Clinical parameters were checked for association with progression in multivariate analysis.

Main outcome measures: The primary outcome was the association between simvastatin use and VF progression.

Results: Thirty-one patients (12.1%) were taking simvastatin (statin+), and 225 patients (87.9%) were not taking simvastatin (statin-). Baseline age, gender, untreated intraocular pressure, VF indices, vertical cup-to-disc ratio, and central corneal thickness (CCT) were comparable between the 2 groups. There were significantly more patients with a history of hypercholesterolemia, systemic hypertension, and ischemic heart disease in the statin+ group. A total of 121 patients (47.3%) showed evidence of VF progression (mean rate of mean deviation loss was -0.30 decibel per year) during the 36 months of follow-up. Simvastatin use was among 8 of 121 patients (6.6%) who progressed compared with 23 of 135 patients (17.0%) who did not progress (P = 0.011). Logistic regression revealed that history of disc hemorrhage (relative risk [RR] 3.26; 95% confidence interval [CI], 1.21-8.76; P = 0.019), history of cerebrovascular accidents (RR 2.28; 95% CI, 1.03-5.06; P = 0.043), and baseline age (per 10 years older; RR 1.38; 95% CI, 1.08-1.76; P = 0.009) were significant risk factors for VF progression, whereas simvastatin use conferred a protective effect (RR 0.36; 95% CI, 0.14-0.91; P = 0.030).

Conclusions: Simvastatin use may be associated with VF stabilization in patients with NTG. A larger scale randomized controlled trial and cost-effectiveness analyses seem warranted.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Anticholesteremic Agents / administration & dosage*
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hypercholesterolemia / drug therapy*
  • Intraocular Pressure
  • Low Tension Glaucoma / physiopathology*
  • Male
  • Prospective Studies
  • Simvastatin / administration & dosage*
  • Tonometry, Ocular
  • Vision Disorders / physiopathology*
  • Visual Field Tests
  • Visual Fields*

Substances

  • Anticholesteremic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Simvastatin

Associated data

  • ClinicalTrials.gov/NCT00321386