FDA Highlights: Statins appear to protect against microvascular complications of diabetes

by Bruce Sylvester – Microvascular complications of diabetes that can lead to blindness and amputations might be reduced by statin therapy, researchers reported on Sept.9, 2014 in The Lancet Diabetes & Endocrinology.

As background, the authors noted that while cholesterol lowering with stain therapy effectively reduces risks of heart attack and stroke in people with type 2 diabetes, it is not yet established whether statins inhibit microvascular complications in these patients.

“Since high levels of blood glucose, the hallmark of diabetes, are linked with microvascular disease, and since statins are suspected of raising glucose levels, we tested the hypothesis that individuals taking a statin before a diagnosis of diabetes might be at increased risk of developing microvascular complications”, said author Børge G Nordestgaard, M.D., Chief Physician in Clinical Biochemistry at Copenhagen University Hospital in Denmark. “Surprisingly, the results showed that statins decreased rather than increased risk of these complications.”

The investigators extracted data from Danish clinical registries. They evaluated the data to see whether statins reduced the incidence of microvascular complications in subjects chosen randomly from all Danish patients with diabetes who were aged 40 years or older, and who were diagnosed between Jan, 1996 and Dec, 2009.

They compared the microvascular outcomes of 15,679 subjects who had taken a statin regularly before their diabetes diagnosis to the same outcomes of 47, 037 patients who had not taken a statin  before diagnosis.

They found that,  over a median follow-up of 2.7 years (maximum 13 years), statin-treated subjects  were 34% less likely to be diagnosed with diabetic neuropathy, 40% less likely to develop diabetic retinopathy and 12% less likely to have gangrene, when  compared to those who had not received statins.

Notably, the risk of diabetic nephropathy was similar in both groups.

Statin users also had slightly higher chance of eventually being diagnosed with diabetes, as shown in prior research.

In a linked Comment, David Preiss, M.D., of the British Heart Foundation Cardiovascular Research Centre at the University of Glasgow, UK, said, “”Statins act by reducing circulating LDL cholesterol and, to a lesser extent, triglycerides. But if statins do protect from microvascular damage, their effect might have little to do with lipid modification. Fibrates are other lipid-modifying agents which have shown promising results for lowering the progression of retinopathy, but this appears to be due to direct anti-inflammatory effects in the eye rather than lipid modification. Statins also have anti-inflammatory effects which might slow the progression of microvascular disease in the eye or kidney. For now, however, any benefit of statins on microvascular complications remains unproven.”