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J Clin Endocrinol Metab. 2017 Jul 1;102(7):2373-2381. doi: 10.1210/jc.2016-3717.

Statin Therapy Reduces Future Risk of Lower-Limb Amputation in Patients With Diabetes and Peripheral Artery Disease.

Hsu CY1,2,3,4, Chen YT1,5, Su YW2,6, Chang CC1,2,7, Huang PH1,2,8, Lin SJ1,2,3,9.

Author information

1
Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan.
2
Cardiovascular Research Center, National Yang-Ming University, Taipei 112, Taiwan.
3
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
4
Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan.
5
Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei 100, Taiwan.
6
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
7
Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan.
8
Division of Cardiology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
9
Department of Medical Research, Taipei Veterans General Hospital, Taipei 112, Taiwan.

Abstract

Context:

Although there is evidence to support the beneficial effects of statins on major cardiovascular events, few studies address the protective effect of statins on limb outcome.

Objective:

To investigate whether the use of statin is associated with a risk reduction in lower-extremity amputation in type 2 diabetes mellitus (DM) patients with peripheral arterial disease (PAD).

Design:

Observational cohort study.

Setting:

A nationwide DM database in Taiwan from 2000 to 2011.

Patients:

A total of 69,332 patients aged ≥20 years with DM and PAD were identified.

Intervention:

Patients were divided into three groups: 11,409 patients were statin users, 4430 patients used nonstatin lipid-lowering agents, and 53,493 patients were nonusers.

Main Outcome Measures:

The primary outcome was lower-extremity amputation. Secondary outcomes were in-hospital cardiovascular death and all-cause mortality.

Results:

Compared with nonusers, statin users were associated with lower risks of lower-extremity amputation [adjusted hazard ration (aHR), 0.75; 95% confidence interval (CI), 0.62 to 0.90], in-hospital cardiovascular death (aHR, 0.78; 95% CI, 0.69 to 0.87), and all-cause mortality (aHR, 0.73; 95% CI, 0.69 to 0.77). In the propensity score matching analysis, the effect of statin on the risk of lower-extremity amputation was consistent. Only statin users were associated with the risk reduction of lower-extremities amputation (HR, 0.77; 95% CI, 0.61 to 0.97) and cardiovascular death (HR, 0.78; 95% CI, 0.68 to 0.89) when taking competing risk of death into consideration.

Conclusions:

Compared with statin nonusers who were never treated with lipid-lowering drugs, this study found that statin users had a lower risk of lower-extremity amputation and cardiovascular death in patients with DM and PAD.

PMID:
28398564
DOI:
10.1210/jc.2016-3717
[Indexed for MEDLINE]

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