Association of statin use and hypertriglyceridemia with diabetic macular edema in patients with type 2 diabetes and diabetic retinopathy

Abstract

BackgroundTo investigate the effects of dyslipidemia and statin therapy on progression of diabetic retinopathy and diabetic macular edema in patients with type 2 diabetes.MethodsThe medical records of 110 patients with type 2 diabetes (70 statin users and 40 non-users) were retrospectively reviewed. The two outcome measures were progression of diabetic retinopathy by two or more steps on the early treatment diabetic retinopathy study scale and diabetic macular edema based on optical coherence tomography. Serum lipid profiles were analyzed from 6 months prior to diagnosis of diabetic macular edema.ResultsDiabetic retinopathy progressed in 23% of statin users and 18% of non-users (p = 0.506), but diabetic macular edema was present in 23% of statin users and 48% of non-users (p = 0.008). Statins reduced low-density lipoprotein cholesterol levels in patients with and without diabetic macular edema (p = 0.043 and p = 0.031, respectively). Among statin users, patients with diabetic macular edema had higher levels of triglycerides (p = 0.004) and lower levels of high-density lipoprotein cholesterol (p = 0.033) than those without diabetic macular edema. Logistic regression analysis showed that statin use significantly lowered the risk of diabetic macular edema [odds ratio (OR): 0.33, 95% confidence interval (CI) 0.12–0.91, p = 0.032]. Hypertriglyceridemia at 6 months prior to development of macular edema was significantly associated with central retinal thickness (OR: 1.52; 95% CI 1.14–2.02, p = 0.005).ConclusionsLipid lowering therapy with statins protected against the development of diabetic macular edema and progression of diabetic retinopathy in patients with type 2 diabetes. Hypertriglyceridemia could be used as a surrogate marker for diabetic macular edema.

Lipid‐lowering medication is associated with decreased risk of diabetic retinopathy and the need for treatment in patients with type 2 diabetes: A real‐world observational analysis of a health claims database

“…Still, simvastatin has been shown to delay the progression of DR in patients with hypercholesterolaemia, 20 and atorvastatin has been shown to decrease hard exudates of the retina and subfoveal migration of the lipids in the fovea, both associated with diabetic macular oedema. 23 Our findings suggest that an association between use of statins and incident DR, any treatment for DR and DME were consistent for statin use. 23 Our findings suggest that an association between use of statins and incident DR, any treatment for DR and DME were consistent for statin use.…”

“…21 The Steno-2 study, in which statin was used in 85% of patients, involved an intensive multifactorial intervention including management of glycaemia, blood pressure and lipid concentration along with lifestyle modification which was associated with a reduction in the risk of microvascular complications including DR. 22 In one study, the risk of DME was also reduced, with a significant reduction in OR of 0.33 (95% CI, 0.12-0.91; P = .032) by statin use in 110 patients with type 2 diabetes mellitus. 23 Our findings suggest that an association between use of statins and incident DR, any treatment for DR and DME were consistent for statin use. Interestingly, point estimates for use of fibrates suggest that they might provide more benefit compared to statins, perhaps explained by the number of patients using fibrates compared to those using statins.…”

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

“…As is known, patients with T2D usually have dyslipidemia, an important risk factor for macroangiopathies such as PAD and CVD, which are manifested by atherosclerosis [46][47][48]. Although there is still no exact definition underlying the association between atherosclerosis and DR, some studies have suggested that the pathogenesis of these 2 conditions may have risk factors in common [49].…”

Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

“…While statin use is associated with improvement in such retinal exudates, systemically it is also associated with a lower degree of myocardial microangiopathy and systolic dysfunction in patients with dilated cardiomyopathy (137). Use of the PPARantagonist, fenofibrate, has been demonstrated to reduce the risk of progression of non-proliferative diabetic retinopathy by up to 40%, but whether this is related to the lipid lowering or other effects is unclear (138,139).…”