Statin Intensity and the Risk of Noninfectious Uveitis

To evaluate whether the 5-year risk of incident noninfectious uveitis (NIU) is associated with the intensity of statin therapy in patients with hyperlipidemia.

Retrospective propensity score-matched cohort study.

Patients diagnosed with hyperlipidemia within a nationwide federated electronic medical record network (TriNetX). Patients initiating high-, medium-, or low-intensity statin therapy were compared with 2 mutually exclusive control cohorts: an active comparator control (proton pump inhibitor users) and an unexposed control cohort. Patients with prior uveitis or any history of fibrate use were excluded.

Each statin intensity cohort underwent 1:1 propensity score matching with both control groups to balance baseline demographics and systemic comorbidities.

Five-year hazard ratios (HRs) with 95% confidence intervals (CIs) for incident overall NIU, anterior uveitis, and posterior/panuveitis.

Before matching, the study identified 32 434 high-intensity, 16 955 medium-intensity, and 4843 low-intensity statin users. Following matching, high-intensity statin therapy was associated with a significantly reduced 5-year risk of overall NIU compared with the unexposed control (HR, 0.81; 95% CI: 0.69-0.95) with a statistically significant reduction against the active control (HR, 0.73; 95% CI: 0.57-0.94). This protective effect was primarily driven by significant reductions in anterior uveitis against both the unexposed control (HR, 0.77; 95% CI: 0.65-0.92) and the active control (HR, 0.72; 95% CI: 0.55-0.94). Medium-intensity statin therapy yielded a significant risk reduction for overall NIU against both the unexposed control (HR, 0.81; 95% CI: 0.66-0.99) and the active control (HR, 0.77; 95% CI: 0.61-0.98), though the reduction in anterior uveitis did not reach statistical significance against either comparison group Low-intensity statin regimens did not significantly alter the risk of NIU or any anatomic subtype across either comparison group. Negative control outcome analysis demonstrated null associations across all cohorts, supporting the validity of the observed findings.

Statin therapy is associated with an intensity-dependent reduction in the 5-year risk of noninfectious uveitis. High-intensity statin regimens confer the most robust and sustained protective benefit, suggesting that higher-potency dosing is necessary to achieve clinically significant modulation of ocular inflammation.

The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.