Lipid-lowering drug atorvastatin as an adjunct in the management of diabetic macular edema

Gupta, Amod; Gupta, Vishali; Thapar, Shveta; Bhansali, Anil

doi:10.1016/j.ajo.2003.11.017

Cited by 122 publications

(121 citation statements)

References 18 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…An interaction was noted between the method of diabetes diagnosis and statin use, with respect to diabetic retinopathy and gangrene, but risk estimates for individuals diagnosed via hospital or prescription records pointed in the same direction (appendix pp [19][20][21]. Other possible interactions were not consistent among several endpoints and, therefore, could represent chance fi ndings.…”

Section: Resultsmentioning

confidence: 98%

“…Diabetic retinopathy was a primary outcome in some randomised trials of statins in individuals with diabetes, in which lipid abnor ma lities were also targeted. [19][20][21][22] In one trial (n=30), a signifi cant reduction in the severity of hard exudates (p=0·007) and subfoveal lipid migration in macular oedema (p=0·04) were noted. 19 In a second trial (n=133), fl uorescein angiography and colour fundus photography worsened in patients allocated to placebo, but not in those allocated to a statin (p=0·009); 20 a similar result was reported in a study of six individuals with type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22] In one trial (n=30), a signifi cant reduction in the severity of hard exudates (p=0·007) and subfoveal lipid migration in macular oedema (p=0·04) were noted. 19 In a second trial (n=133), fl uorescein angiography and colour fundus photography worsened in patients allocated to placebo, but not in those allocated to a statin (p=0·009); 20 a similar result was reported in a study of six individuals with type 1 diabetes. 21 Finally, in a randomised trial of 166 individuals with type 2 diabetes who received multifactorial interven tion, including statin use versus placebo, 22 secondary outcomes included a reduced risk of diabetic retinopathy (hazard ratio 0·57, 95% CI 0·37-0·88), neuropathy (0·53, 0·34-0·81), and nephropathy (0·44, 0·25-0·77).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

Nielsen

Nordestgaard

2014

The Lancet Diabetes & Endocrinology

103

View full text Add to dashboard Cite

SummaryBackground The role of statins in the development of microvascular disease in patients with diabetes is unknown. We tested the hypothesis that statin use increases the risk of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and gangrene of the foot in individuals with diabetes. MethodsWe identifi ed all patients living in Denmark who were aged 40 years or older and were diagnosed with incident diabetes between Jan 1, 1996, and Dec 31, 2009. We obtained patients' data from the Danish Patient Registry and information on drug use from the Danish Registry of Medicinal Product Statistics. We randomly selected 15 679 individuals from the database who had used statins regularly until their diagnosis of diabetes (statin users) and matched them in a 1:3 ratio with 47 037 individuals who had never used statins before diagnosis (non-statin users). Our primary outcome was to compare the cumulative incidence of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, or gangrene of the foot in statin users versus non-statin users. We analysed data with Cox regression models, adjusted for covariates including sex, age at diabetes diagnosis, and method of diabetes diagnosis. To address potential biases between statin users and non-statin users, we made adjustments to our analysis with a propensity score and with other factors. Median follow-up was 2·7 years (range 0-13).Findings During 215 725 person-years of follow-up, 2866 patients developed diabetic retinopathy, 1406 developed diabetic neuropathy, 1248 developed diabetic nephropathy, and 2392 developed gangrene of the foot. Compared with non-statin users, statin users had a lower cumulative incidence of diabetic retinopathy (hazard ratio 0·60, 95% CI 0·54-0·66; p<0·0001), diabetic neuropathy (0·66, 0·57-0·75; p<0·0001), and gangrene of the foot (0·88, 0·80-0·97; p=0·010), but not diabetic nephropathy (0·97, 0·85-1·10; p=0·62). These results were similar after adjusting for the competing risk of death, after matching for a propensity score, after adjusting for visits to a family doctor, and by stratifi cation on covariates. The corresponding multivariable adjusted hazard ratio for risk of diabetes in the total population was 1·17 (95% CI 1·14-1·21; p<0·0001).Interpretation Use of statins before diagnosis of incident diabetes was not associated with an increased risk of microvascular disease. Whether statins are protective against some forms of microvascular disease-a possibility raised by these data-will need to be addressed in other studies similar to ours, in mendelian randomisation studies, and preferably in randomised controlled trials. Funding

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

Nielsen

Nordestgaard

2014

The Lancet Diabetes & Endocrinology

103

View full text Add to dashboard Cite

show abstract

“…[39][40][41] However, there was no evidence of improvement in visual acuity, which was not surprising as patients had severe retinopathy and poor vision at baseline. A number of subsequent studies showed improvement in macular oedema and regression of hard exudates with statin therapy, [42][43][44][45] as well as significant improvement in worsening of visual acuity. 44 However, these studies were in small numbers of patients, and in most cases, involved limited treatment duration.…”

Section: Statins and Fibratesmentioning

confidence: 99%

Management of diabetic retinopathy: could lipid-lowering be a worthwhile treatment modality?

Dodson

2009

Eye

View full text Add to dashboard Cite

Diabetic eye disease confers substantial burden on the patient quality of life. Current therapeutic strategies indicate an unmet clinical need for preventive therapy. Tight control of blood pressure and glycaemia are mandatory components of primary prevention strategies, but are insufficient to eliminate risk in all patients. A body of evidence supports a role for lipid-modifying therapy in reducing the diabetic retinopathy endpoints. Although inconclusive for statin therapy, results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study show beneficial effects of fenofibrate in reducing the requirement for laser therapy, and particularly in preventing disease progression in patients with pre-existing diabetic retinopathy. However, there is a need for confirmation of these findings in large prospective studies with progression of retinopathy as the primary endpoint, such as the ACCORD-EYE (Action to Control Cardiovascular Risk in Diabetes-EYE) study, and in a clinical trial specifically conducted for diabetic maculopathy. In addition, elucidation of the mechanism(s) of effect of fenofibrate is indicated.

show abstract

“…3 Hypertriglyceridaemia has recently been shown to be associated with diabetic retinopathy, 4,5 with high statin doses being effective in treating hypertriglyceridaemia. 6 A striking feature of this case was the massive degree of exudative retinopathy on presentation and the almost complete resolution following serum lipid reduction.…”

Section: Commentmentioning

confidence: 99%

Dramatic resolution of massive retinal hard exudates after correction of extreme dyslipidaemia

Waller

Thyagarajan

Kaplan

et al. 2009

Eye

View full text Add to dashboard Cite

Lipid-lowering drug atorvastatin as an adjunct in the management of diabetic macular edema

Cited by 122 publications

References 18 publications

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

Management of diabetic retinopathy: could lipid-lowering be a worthwhile treatment modality?

Dramatic resolution of massive retinal hard exudates after correction of extreme dyslipidaemia

Contact Info

Product

Resources

About