Author: Steve Freed, R.PH., CDE
Development of diabetic retinopathy found to be significantly reduced .
In a cohort of 38,000 patients with type 2 diabetes and elevated cholesterol levels, researchers found that those on statins had a significantly reduced risk of developing diabetic retinopathy, compared with those not taking statins.
The statin group also had lower risks of new-onset diabetic neuropathy, new-onset diabetic foot ulcers, and major adverse cardiovascular events than the non-statin group.
Diabetic retinopathy is a leading microvascular complication of diabetes. According to one estimate, as many as 191 million people worldwide will have developed the vision-threatening eye disorder by 2030.
In the study, statin therapy was also associated with a lower need for invasive treatments for vision-threatening diabetic retinopathy, and the benefits of statin treatment were dose-dependent. While several widely reported studies, including the ACCORD-EYE study, have suggested that statin treatment slows progression of diabetic retinopathy in patients with diabetes and dyslipidemia, the new study is among the first to assess statin use for the primary prevention of the eye disorder.
Yih-Shiou Hwang, MD, PhD, of Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues conducted the population-based cohort study using the National Health Insurance Research Database (NHIRD) of longitudinal claims data from medical practices receiving payment from the single-payer Taiwan National Health Insurance.
Of 1,648,305 patients with type 2 diabetes recorded in the database from 1998 through 2013, a total of 219,359 were eligible for the analysis, including 199,760 patients taking statins and 19,599 not taking statins.
The analysis included 18,947 patients in the statin group (10,436 women and 8,511 men; mean [SD] age, 61.5 [10.8]) and 18,947 patients in the non-statin group (10,430 women and 8,517 men; mean [SD] age, 61.0 [11.0]), with a mean follow-up of 7.6 years for the statin group and 7.3 years for the non-statin group. During the study period, 2,004 patients in the statin group (10.6%) and 2,269 in the non-statin group (12.0%) developed diabetic retinopathy.
The analysis also revealed that: Patients in the statin group had a significantly lower rate of diabetic retinopathy, nonproliferative diabetic retinopathy and proliferative diabetic retinopathy compared with patients in the non-statin group.
Patients also had lower rates of vitreous hemorrhage, tractional retinal detachment, and macular edema.
Compared with the non-statin group, the statin users had lower rates of interventions, such as retinal laser treatment, intravitreal injection, and vitrectomy.
A correlation was also noted for statin therapy with reduced risks for major adverse cardiovascular events, new-onset diabetic neuropathy, and new-onset diabetic foot ulcers (hazard ratio, 0.81, 0.85, and 0.73, respectively).
Statin therapy was also associated with lower risks of major adverse cardiovascular events, new-onset diabetic neuropathy, and new-onset diabetic foot ulcers.
In the study, they found that statin therapy alone was associated with a reduced risk of diabetic retinopathy compared with the non-statin group. The finding could expand the conclusion from the ACCORD-EYE study that the group receiving statins and fenofibrate had the lowest risk of diabetic retinopathy followed by the group receiving statins alone (10.6% in this study and 10.2% in the ACCORD-EYE study).
In another study in 2014 , Raimo Tuuminen and colleagues showed lower intravitreal levels of pro-angiogenic factors, angiopoietin 2, vascular endothelial growth factor, fibrotic factors, matrix metalloproteinase 9, and transforming growth factor β1 in patients with diabetic retinopathy who are treated with a statin versus those who did not receive a statin.
Practice Pearls: The results from this study and the ACCORD-EYE study could offer medical strategies to reduce the risk of diabetic retinopathy.
It was noted that statins have been shown to have pleiotropic effects, including improved endothelial function and anti-inflammatory, anti-oxidation, and antithrombotic effects.
Statins have a significant benefit of reducing the risk of developing diabetic retinopathy.
Kang EYC, et al “Association of statin therapy with prevention of vision-threatening diabetic retinopathy” JAMA Ophthalmol 2019; DOI: 10.1001/jamaophthalmol.2018.6399.
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