title: Simvastatin and disease stabilization in normal tension glaucoma: a cohort study.
abstract: OBJECTIVE
  To investigate whether simvastatin use is associated with visual field (VF) stabilization in patients with normal tension glaucoma (NTG).
  
  
  METHODS
  Prospective cohort study (ClinicalTrials.gov Identifier: NCT00321386).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong Special Administrative Region, The People's Republic of China. dexleung@alumni.cuhk.net
authors.forename: Dexter Y L
authors.initials: DY
authors.lastname: Leung
authors.forename: Felix C H
authors.initials: FC
authors.lastname: Li
authors.forename: Yolanda Y Y
authors.initials: YY
authors.lastname: Kwong
authors.forename: Clement C Y
authors.initials: CC
authors.lastname: Tham
authors.forename: Stanley C C
authors.initials: SC
authors.lastname: Chi
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D007429:Intraocular Pressure; D057066:Low Tension Glaucoma / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D019821:Simvastatin / Q000008:administration & dosage*; D014065:Tonometry, Ocular; D014786:Vision Disorders / Q000503:physiopathology*; D058609:Visual Field Tests; D014794:Visual Fields
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin