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ACE inhibitor use and risk of cataract: a case–control analysis
  1. Claudia Becker1,2,
  2. Susan S Jick3,4,
  3. Christoph R Meier1,2,3
  1. 1 Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
  2. 2 Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
  3. 3 Boston Collaborative Drug Surveillance Program, Lexington, Massachusetts, USA
  4. 4 School of Public Health, Boston University, Boston, Massachusetts, USA
  1. Correspondence to Professor Christoph R Meier, Basel Pharmacoepidemiology Unit, Hospital Pharmacy, University Hospital Basel, Basel 4051, Switzerland; Christoph.Meier{at}


Background/Aim Use of ACE inhibitors (ACEIs) has been associated with an increased risk of cataract in a previous observational study in humans. In contrast, ACEIs were associated with beneficial effects on cataract development in experimental studies. We assessed the risk of cataract in relation to exposure to ACEI and other antihypertensive drugs.

Methods This is a case-control study based on data from the UK-based Clinical Practice Research Datalink (CPRD). We included first-time cataract patients aged ≥40 years between 1995 and 2015 and an equal number of cataract-free controls. We matched the controls to cases on age, sex, general practice, date of first cataract (ie, index date) and years of history in the CPRD prior to the index date. We assessed the number of prescriptions for ACEI and other antihypertensive drugs in detail and explored the use of single ACEI substances. We performed conditional logistic regression and conducted various sensitivity analyses to test the robustness of our findings. We calculated the risk of cataract associated with previous exposure to ACEI, measured as OR with 95% CIs, and adjusted the multivariable model for body mass index, smoking, diabetes, hypertension, prescriptions of systemic corticosteroids and other antihypertensive drugs.

Results We identified 206 931 cataract cases and the same number of matched controls. Use of ACEI was not associated with a materially altered risk of cataract compared with non-use of ACEI, neither in the main analysis (OR 1.06, 95% CI 1.04 to 1.08) nor in any of the sensitivity or stratified analyses.

Conclusion In our large observational study, use of ACEI was not associated with an altered risk of cataract.

  • drugs
  • epidemiology

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  • Presented at The International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Boston, Massachusetts, USA, 22–26 August 2015.

  • Contributors Substantial contributions to the design of the work: CB, CRM. Acquisition: SSJ, CRM. Analysis: CB. Interpretation of data: CB, SSJ, CRM. Drafting the work: CB. Revising it critically for important intellectual content: SSJ, CRM. Final approval of the version published: CB, SSJ, CRM. CB, SSJ, CRM agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol (14_010) was reviewed and approved by the Independent Scientific Advisory Committee for MHRA database research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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