Statin reduces the incidence of diabetic retinopathy and its need for intervention: A systematic review and meta-analysis

Pranata, Raymond; Vania, Rachel; Victor, Andi Arus

doi:10.1177/1120672120922444

Cited by 29 publications

(20 citation statements)

References 34 publications

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“…More recently in 2020, Pranata et al performed a systematic literature search and demonstrated that statin treatment was strongly correlated with a remarkably decreased risk of diabetic retinopathy. Moreover, statin treatment also lowered the necessary for the therapy with intravitreal injection and vitrectomy [44]. Similar conclusions could also be seen in another study which aimed to assess the function of lipid-lowering agents on diabetic retinopathy and its related complications requiring intervention [45].…”

Section: Statinssupporting

confidence: 63%

Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy

Chou

et al. 2020

Lipids Health Dis

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Hyperlipidemia is correlated with a series of health problems. Notably, aside from its established role in promoting cardiovascular morbidity and mortality, hyperlipidemia has also been considered for modulating the risk and the severity of multiple metabolic disorders. According to the results of epidemiologic investigations, several certain circulating lipoprotein species are correlated with the prevalence of diabetic retinopathy, suggesting that the physiological and pathological role of these lipoproteins is analogous to that observed in cardiovascular diseases. Furthermore, the lipid-lowering treatments, particularly using statin and fibrate, have been demonstrated to ameliorate diabetic retinopathy. Thereby, current focus is shifting towards implementing the protective strategies of diabetic retinopathy and elucidating the potential underlying mechanisms. However, it is worth noting that the relationship between major serum cholesterol species and the development of diabetic retinopathy, published by other studies, was inconsistent and overall modest, revealing the relationship is still not clarified. In this review, the current understanding of hyperlipidemia in pathogenesis of diabetic retinopathy was summarized and the novel insights into the potential mechanisms whereby hyperlipidemia modulates diabetic retinopathy were put forward.

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Section: Statinssupporting

confidence: 63%

Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy

Chou

et al. 2020

Lipids Health Dis

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“…A search for a safer systemic approach to preventing or delaying development of complications has re-examined the benefits of the lipid-lowering drug fenofibrate ( 223 , 224 ), but the, albeit uncommon, side-effects have also prevented its widespread use. Experience with the liberally prescribed statins has also been examined as a possible means of eliminating the hyperlipidemic risk factor for DR, and there is some evidence from RCT’s ( 225 – 227 ) but a critical analysis of published data suggests that the quality and reporting of the data may be flawed ( 228 ). Experimentally, rosuvastatin has been shown to inhibit leukostasis in which the effect appeared to act on the endothelium rather than the leukocytes, thus pointing to a primary metabolic defect in the endothelium initiating leukostasis ( 145 ).…”

Section: Preventing and Treating The Microvasculopathy Of Obesity/thementioning

confidence: 99%

The Role of Inflammation in Diabetic Retinopathy

2020

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Inflammation is central to pathogenic processes in diabetes mellitus and the metabolic syndrome and particularly implicates innate immunity in the development of complications. Inflammation is a primary event in Type 1 diabetes where infectious (viral) and/or autoimmune processes initiate disease; in contrast, chronic inflammation is typical in Type 2 diabetes and is considered a sequel to increasing insulin resistance and disturbed glucose metabolism. Diabetic retinopathy (DR) is perceived as a vascular and neurodegenerative disease which occurs after some years of poorly controlled diabetes. However, many of the clinical features of DR are late events and reflect the nature of the retinal architecture and its cellular composition. Retinal microvascular disease is, in fact, an early event pathogenetically, induced by low grade, persistent leukocyte activation which causes repeated episodes of capillary occlusion and, progressive, attritional retinal ischemia. The later, overt clinical signs of DR are a consequence of the retinal ischemia. Metabolic dysregulation involving both lipid and glucose metabolism may lead to leukocyte activation. On a molecular level, we have shown that macrophage-restricted protein tyrosine phosphatase 1B (PTP1B) is a key regulator of inflammation in the metabolic syndrome involving insulin resistance and it is possible that PTP1B dysregulation may underlie retinal microvascular disease. We have also shown that adherent CCR5 + CD11b + monocyte macrophages appear to be selectively involved in retinal microvascular occlusion. In this review, we discuss the relationship between early leukocyte activation and the later features of DR, common pathogenetic processes between diabetic microvascular disease and other vascular retinopathies, the mechanisms whereby leukocyte activation is induced in hyperglycemia and dyslipidemia, the signaling mechanisms involved in diabetic microvascular disease, and possible interventions which may prevent these retinopathies. We also address a possible role for adaptive immunity in DR. Although significant improvements in treatment of DR have been made with intravitreal anti-VEGF therapy, a sizeable proportion of patients, particularly with sight-threatening macular edema, fail to respond. Alternative therapies targeting inflammatory processes may offer an advantage.

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“…The FIELD study 12) showed HDL-C, LDL-C, and TG levels were not the significant markers for laser treatment. However, fibrate 12) and statin 36) intake was shown to reduce the need for laser treatment in randomized controlled trial and metaanalysis. Taken together, there might be a weak or borderline association between LDL-C and the risk for diabetic retinopathy.…”

Section: Lipid Markers For Predicting the Need For Laser Treatmentmentioning

confidence: 99%

Small Dense Low-Density Lipoprotein Cholesterol is a Potential Marker for Predicting Laser Treatment for Retinopathy in Diabetic Patients

Nakayama

Morita

Sato

et al. 2022

JAT

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We explored the superiority of small dense low-density lipoprotein cholesterol (sdLDL-C) as a marker for predicting not only the occurrence of cardiovascular (CV) events but also the need for laser treatment in patients with hypercholesterolemia and diabetic retinopathy. Methods:We performed a sub-analysis of the intEnsive statin therapy for hyper-cholesteroleMic Patients with diAbetic retinopaTHY (EMPATHY) study (n 5042), in which patients were assigned randomly to intensive or standard statin therapy targeting low-density lipoprotein cholesterol 70 mg/dl or 100-120 mg/dl. Using the survival analysis, the risks for CV events and the need for laser treatment were evaluated according to the lipids one year after registration. Results:The patients were 63 11 years old. LDL-C and sdLDL-C levels were 98 25 and 32 14 mg/dl, respectively, one year after registration. The sdLDL-C level had a strong positive correlation with apolipoprotein B level (r 0.83 at registration). SdLDL-C was a sensitive marker for predicting CV events when comparing among the quartiles according to sdLDL-C levels (hazard ratios: HR for quartiles 1-4 were 1.0, 1.4, 1.6, and 2.5, respectively; p for trend 0.01). Also, sdLDL-C was a sensitive marker for predicting the need for laser treatment among lipids (log rank, p 0.009), especially in patients with elderly ( 65 yrs) and obesity (BMI 25 kg/m 2 ). Conclusions: SdLDL-C is a sensitive target marker to predict cardiovascular events as well as the need for laser treatment in patients with hypercholesterolemia and diabetic retinopathy.diseases 3,4) . Lipid markers other than LDL-C, such as total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), triglyceriderich lipoprotein cholesterol (TRL-C), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB), are also potential markers for predicting CV events 1,2,5,6,7) .

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Statin reduces the incidence of diabetic retinopathy and its need for intervention: A systematic review and meta-analysis

Cited by 29 publications

References 34 publications

Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy

Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy

The Role of Inflammation in Diabetic Retinopathy

Small Dense Low-Density Lipoprotein Cholesterol is a Potential Marker for Predicting Laser Treatment for Retinopathy in Diabetic Patients

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