Cited by 52Lipoproteins and Cardiovascular HealthDiabetic Foot Ulcer Assessment and ManagementPeripheral Artery Disease Management

Statin use and lower extremity amputation risk in nonelderly diabetic patients

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Sohn, Min-Woong, Meadows, Judith L., Oh, Elissa H., Budiman-Mak, Elly, Lee, Todd A., Stone, Neil J., Pearce, William B.·2013·Journal of Vascular Surgery

Abstract

Objective To examine the association between use of statin and non-statin cholesterol-lowering medications and risk of nontraumatic major lower-extremity amputations (LEA) and treatment failure (LEA or death). Design of Study A retrospective cohort of patients with Type I and Type 2 diabetes mellitus (diabetes) was followed for five years between 2004 and 2008. The follow-up exposure duration was divided into 90-day periods. Use of cholesterol-lowering agents, diabetic medications, hemoglobin A1c, body mass index, and systolic and diastolic blood pressures were observed in each period. Demographic factors were observed at baseline. Major risk factors of LEA including peripheral neuropathy, PAD, and foot ulcers were observed at baseline and were updated for each period. LEA and deaths were assessed in each period and their hazard ratios were estimated. Setting US Department of Veterans Affairs Healthcare system (VA) Subjects Cholesterol drug-naïve patients with Type I or II diabetes who were treated in the VA in 2003 and were <65 years old at the end of follow-up. Results Of 83,593 patients in the study cohort, 217 (0.3%) patients experienced a major LEA and 11,716 (14.0%) patients experienced an LEA or death (treatment failure) after a mean follow-up of 4.6 years. Compared to patients who did not use cholesterol-lowering agents, statin users were 35% - 43% less likely to experience an LEA (HR = 0.65; 95% CI, 0.42–0.99) and a treatment failure (HR = 0.57; 95% CI, 0.54–0.60). Users of other cholesterol-lowering medications were not significantly different in LEA risk (HR = 0.95; 95% CI, 0.35–2.60) but had a 41% lower risk of treatment failure (HR = 0.59; 95% CI, 0.51–0.68). Conclusions This is the first study to report a significant association between statin use and diminished amputation risk among patients with diabetes. In this non-randomized cohort, beneficial effects of statin therapy were similar to that seen in large-scale clinical trial experience. For LEA risk, those given non-statins did not have a statistically significant benefit and its effect on LEA risk was much smaller compared to statins.. Unanswered questions to be explored in future studies include a comparison of statins of moderate versus high potency in those with high risk of coronary heart disease and an exploration of whether the effects seen in this study are simply effects of cholesterol-lowering or possibly pleiotropic effects.

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Crossref · 10.1016/j.jvs.2013.06.069

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  • Several observational studies have shown that statins reduce the rate of amputation with relative risk reductions between 18% and 35% that are not seen with the use of nonstatin lipid-lowering therapies.

    “Several observational studies have shown that statins reduce the rate of amputation with relative risk reductions between 18% and 35% that are not seen with the use of nonstatin lipid-lowering therapies such as fibrates, bile acid sequestrants, nicotinic acid, and cholesterol absorption inhibitors.67,68”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [68]

    The Discussion reports a 35% lower amputation risk among statin users in this observational cohort of nonelderly patients with diabetes. It does not report an 18% reduction, and its finding for nonstatin therapies is more cautious: their association with lower risk was not statistically significant, but the study was underpowered to assess it. The Discussion also reports fewer minor amputations with fenofibrate in another trial. (LLM, conf=0.87)

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Authors
Sohn, M.-W., Meadows, J. L., Oh, E. H., Budiman-Mak, E., Lee, T. A., Stone, N. J., & Pearce, W. B.
Affiliations
  • Northwestern University (US)
  • Edward Hines, Jr. VA Hospital (US)
Corresponding author
Sohn, Min-Woong
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2013-12
Volume
58
Issue
6
Pages
1578-1585.e1
ISSN
0741-5214 (ISSN-L)
OpenAlex
W2076790234
Cited by
52
References
32
Citations by year
2026: 2 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 9 · 2018: 1 · 2017: 9 · 2016: 5 · 2015: 2 · 2014: 4
FWCI
3.62
Type
journal article
Language
en
Open access
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Agency for Healthcare Research and Quality (R01HS018542, 1r01hs018542-01a2)
  • National Heart, Lung, and Blood Institute (T32HL094293)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
Keywords
statins, lower limb amputation, diabetes mellitus, cholesterol-lowering drugs, non-statin lipid-lowering therapy, type 1 diabetes, type 2 diabetes, treatment failure, peripheral arterial disease, peripheral neuropathy, foot ulcer, veterans, cardiovascular risk reduction, HbA1c, blood pressure, body mass index, statin safety
MeSH terms
Amputation, Surgical, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Illinois, Leg, Male, Middle Aged, Retrospective Studies, Risk Factors, Diabetic Foot, Disease Progression, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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