As many as 191 million people worldwide will develop diabetic retinopathy by 2030. According to a new study published in JAMA Ophthalmology in January 2019, the use of statins in individuals with diabetes significantly decreases the risk of developing diabetic retinopathy, a leading microvascular complication of diabetes.

Senior author Yih-Shiou Hwang, MD, PhD, of Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues conducted a study of a population-based cohort comprising 38,000 patients identified in the National Health Insurance Research Database, which is a repository of longitudinal claims data from medical practices receiving payment from the single-payer Taiwan National Health Insurance. These individuals were diagnosed with both type 2 diabetes (T2DM) and elevated cholesterol levels.

The researchers compared outcomes that included any treatment for diabetic retinopathy and/or stage of diagnosed retinopathy in patients taking statins and those not taking statins. No other lipid-lowering medications were permitted to be used by patients enrolled in the study. Of the 1,648,305 patients initially identified with T2DM, just 18,947 patients were eligible for inclusion in the statin group (10,436 women and 8,511 men; mean [standard deviation; SD] age, 61.5 [10.8] years) and 18,947 patients were eligible for the nonstatin group (10,430 women and 8,517 men; mean [SD] age, 61.0 [11.0] years). Mean follow-up was 7.6 years for the statin group and 7.3 years for the nonstatin group.

The authors reported that 2,004 patients in the statin group (10.6%), compared with 2,269 patients in the nonstatin group (12%), developed diabetic retinopathy during the study period. The statin group was shown to have significantly lower rates of diabetic retinopathy (hazard ratio [HR], 0.86; 95% CI, 0.81-0.91); nonproliferative diabetic retinopathy (HR, 0.92; 95% CI, 0.86-0.99); proliferative retinopathy (HR, 0.64; 95% CI, 0.58-0.70); vitreous hemorrhage (HR, 0.62; 95% CI, 0.54-0.71); macular edema (HR, 0.60; 95% CI, 0.46-0.79); and tractional retinal detachment (HR, 0.61; 95% CI, 0.47-0.79) compared with the nonstatin group.

In addition, individuals receiving statins were reported to experience lower rates of interventions, such as retinal laser treatment, vitrectomy, and intravitreal injection, as well as fewer major adverse cardiovascular events.

The authors commented that despite study limitations, their results were notable. “For patients with type 2 diabetes and dyslipidemia, statin therapy was associated with a decreased risk of diabetic retinopathy. Statin therapy could also retard the progression of vision threatening diabetic retinopathy and reduce the number of subsequent retinal laser treatments, intravitreal injections and vitrectomies,” they said.
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