‘Statins in retinal disease’

Abstract

Statins are known for their blood cholesterol-lowering effect and are widely used in patients with cardiovascular and metabolic diseases. Research over the past three decades shows that statins have diverse effects on different pathophysiological pathways involved in angiogenesis, inflammation, apoptosis, and anti-oxidation, leading to new therapeutic options. Recently, statins have attracted considerable attention for their immunomodulatory effect. Since immune reactivity has been implicated in a number of retinal diseases, such as uveitis, age-related macular degeneration (AMD) and diabetic retinopathy, there is now a growing body of evidence supporting the beneficial effects of statins in these retinopathies. This review evaluates the relationship between statins and the pathophysiological basis of these diseases, focusing on their potential role in treatment. A PubMed database search and literature review was conducted. Among AMD patients, there is inconsistent evidence regarding protection against development of early AMD or delaying disease progression; though they have been found to reduce the risk of developing choroidal neovascular membranes (CNV). In patients with retinal vein occlusion, there was no evidence to support a therapeutic benefit or a protective role with statins. In patients with diabetic retinopathy, statins demonstrate a reduction in disease progression and improved resolution of diabetic macular oedema (DMO). Among patients with uveitis, statins have a protective effect by reducing the likelihood of uveitis development.

Oxidative Stress and Microvascular Alterations in Diabetic Retinopathy: Future Therapies

“…A recent systematic review and meta-analysis found no differences in triglycerides, serum total cholesterol, and high-density lipoprotein cholesterol among patients with or without DR [35]. However, many studies have shown how using lipid-lowering medication, such as statins [171–173] or fenofibrate [35, 173], reduce DR progression. Recently, a study used an animal model and described how fenofibrate inhibited the expression of NF- κ B and inflammatory chemokines, and also reduced oxidative damage in lipids, DNA, and proteins in diabetic retinas [174].…”

Dietary Polyphenols in Age-Related Macular Degeneration: Protection against Oxidative Stress and Beyond

“…The environmental/lifestyle factors described as capable of influencing the induction and/or progression of AMD include smoking, obesity, high fat, low antioxidant diet, and exposure to UV and blue light (reviewed in [13]). Some cardiovascular, immunological, and inflammatory biomarkers are reported to be linked to AMD [14–16]. However, except for age, familial history, genetic predisposition, and smoking, other AMD risk factors are still controversial and require further study to confirm their involvement in AMD pathogenesis.…”

Association between Statins and Retinal Vascular Occlusion: A Population-Based Cohort Study

“…In addition to their anti-inflammatory action, statins may have a protective effect on the microvascular endothelium in retinal ischemia models, thereby preventing pathological neovascularization [ 22 ]. Low doses of statins promoted vascular repair mechanisms by upregulating nitric oxide (NO) and vascular endothelial growth factor (VEGF) levels [ 23 ].…”