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

• Published in: The journal of clinical endocrinology and metabolism Vol. 102; no. 7; pp. 2373 - 2381
• Main Authors: Hsu, Chien-Yi, Chen, Yung-Tai, Su, Yu-Wen, Chang, Chun-Chin, Huang, Po-Hsun, Lin, Shing-Jong
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.07.2017
• Subjects: Aged; Amputation; Amputation - statistics & numerical data; Cardiovascular diseases; Cohort Studies; Comorbidity; Confidence Intervals; Databases, Factual; Death; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - drug therapy; Diabetic Angiopathies - epidemiology; Extremities; Female; Follow-Up Studies; Health risk assessment; Health risks; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Lower Extremity - surgery; Male; Middle Aged; Mortality; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - drug therapy; Peripheral Arterial Disease - epidemiology; Propensity Score; Retrospective Studies; Risk factors; Risk Reduction Behavior; Statins; Survival Analysis; Taiwan; Vascular diseases
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2016-3717

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. 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). Observational cohort study. A nationwide DM database in Taiwan from 2000 to 2011. A total of 69,332 patients aged ≥20 years with DM and PAD were identified. 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. The primary outcome was lower-extremity amputation. Secondary outcomes were in-hospital cardiovascular death and all-cause mortality. 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. 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.