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Original Investigation
January 10, 2019

Association of Statin Therapy With Prevention of Vision-Threatening Diabetic Retinopathy

Author Affiliations
  • 1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
  • 2College of Medicine, Chang Gung University, Taoyuan, Taiwan
  • 3Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
  • 4MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 5Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
  • 6Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
  • 7Department of Nephrology, Yang Ming Hospital, Taoyuan, Taiwan
  • 8Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
JAMA Ophthalmol. Published online January 10, 2019. doi:10.1001/jamaophthalmol.2018.6399
Key Points

Question  What is the association of statin therapy with development of diabetic retinopathy in patients with type 2 diabetes and dyslipidemia?

Findings  In this cohort study conducted among 37 894 Taiwanese patients with type 2 diabetes and dyslipidemia, those taking statins had a lower rate of diabetic retinopathy and need for treatments for vision-threatening diabetic retinopathy than those not taking statins. When treatment was required, patients taking statins needed a smaller number of interventions than patients not taking statins.

Meaning  These results suggest that statins are associated with a decreased prevalence of diabetic retinopathy and may decrease the progression of diabetic retinopathy in patients with type 2 diabetes and dyslipidemia.

Abstract

Importance  Diabetic retinopathy is the leading cause of blindness in working-age adults. Studies have suggested that statins may reduce the risk of developing diabetic retinopathy.

Objective  To investigate the association between statin therapy and the development of diabetic retinopathy in patients with diabetes and dyslipidemia.

Design, Setting, and Participants  This population-based cohort study, conducted among 37 894 Taiwanese patients between January 1, 1998, and December 31, 2013, used the National Health Insurance Research Database to identify patients with type 2 diabetes and dyslipidemia. Outcomes were compared between those taking statins and those not taking statins. Statistical analysis was performed from May 1 to 31, 2018.

Exposure  Statin therapy with a medication possession rate of 80% or more with no other lipid-lowering medications.

Main Outcomes and Measures  Any stage of diabetic retinopathy and treatments for vision-threatening diabetic retinopathy.

Results  Of 1 648 305 patients with type 2 diabetes, 219 359 were eligible for analysis over the study period, including 199 760 patients taking statins and 19 599 patients not taking statins. After propensity score matching, there were 18 947 patients in the statin group (10 436 women and 8511 men; mean [SD] age, 61.5 [10.8] years) and 18 947 patients in the nonstatin group (10 430 women and 8517 men; mean [SD] age, 61.0 [11.0] years), with a mean follow-up of 7.6 years for the statin group and 7.3 years for the nonstatin group. During the study period, 2004 patients in the statin group (10.6%) and 2269 patients in the nonstatin group (12.0%) developed diabetic retinopathy. Patients in the statin group had a significantly lower rate 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 diabetic retinopathy (HR, 0.64; 95% CI, 0.58-0.70), vitreous hemorrhage (HR, 0.62; 95% CI, 0.54-0.71), tractional retinal detachment (HR, 0.61; 95% CI, 0.47-0.79), and macular edema (HR, 0.60; 95% CI, 0.46-0.79) than the nonstatin group, as well as lower rates of interventions such as retinal laser treatment (HR, 0.71; 95% CI, 0.65-0.77), intravitreal injection (HR, 0.74; 95% CI, 0.61-0.89), and vitrectomy (HR, 0.58; 95% CI, 0.48-0.69), along with a smaller number of the interventions (retinal lasers: rate ratio, 0.61; 95% CI, 0.59-0.64; intravitreal injections: rate ratio, 0.68; 95% CI, 0.61-0.76; and vitrectomies: rate ratio, 0.54; 95% CI, 0.46-0.63). Statin therapy was also associated with lower risks of major adverse cardiovascular events (HR, 0.81; 95% CI, 0.77-0.85), new-onset diabetic neuropathy (HR, 0.85; 95% CI, 0.82-0.89), and new-onset diabetic foot ulcers (HR, 0.73; 95% CI, 0.68-0.78).

Conclusions and Relevance  Statin therapy was associated with a decreased risk of diabetic retinopathy and need for treatments for vision-threatening diabetic retinopathy in Taiwanese patients with type 2 diabetes and dyslipidemia.

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