Statin therapy reduces future risk of lower-limb amputation in patients with diabetes and peripheral artery disease

Chien Yi Hsu, Yung Tai Chen, Yu Wen Su, Chun Chin Chang, Po Hsun Huang, Shing Jong Lin

Research output: Contribution to journalArticle

12 Citations (Scopus)

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 lowerextremity 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], inhospital 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.

Original languageEnglish
Pages (from-to)2373-2381
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number7
DOIs
Publication statusPublished - Jul 1 2017

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Peripheral Arterial Disease
Medical problems
Amputation
Lower Extremity
Confidence Intervals
Hazards
Diabetes Mellitus
Therapeutics
Risk Reduction Behavior
Lipids
Propensity Score
Mortality
Risk-Taking
Taiwan
Type 2 Diabetes Mellitus
Observational Studies
Cause of Death
Cohort Studies
Extremities

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Statin therapy reduces future risk of lower-limb amputation in patients with diabetes and peripheral artery disease. / Hsu, Chien Yi; Chen, Yung Tai; Su, Yu Wen; Chang, Chun Chin; Huang, Po Hsun; Lin, Shing Jong.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 102, No. 7, 01.07.2017, p. 2373-2381.

Research output: Contribution to journalArticle

Hsu, Chien Yi ; Chen, Yung Tai ; Su, Yu Wen ; Chang, Chun Chin ; Huang, Po Hsun ; Lin, Shing Jong. / Statin therapy reduces future risk of lower-limb amputation in patients with diabetes and peripheral artery disease. In: Journal of Clinical Endocrinology and Metabolism. 2017 ; Vol. 102, No. 7. pp. 2373-2381.
@article{f8f3b0a08b004539a31b214ccfa856ee,
title = "Statin therapy reduces future risk of lower-limb amputation in patients with diabetes and peripheral artery disease",
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 lowerextremity 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], inhospital 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.",
author = "Hsu, {Chien Yi} and Chen, {Yung Tai} and Su, {Yu Wen} and Chang, {Chun Chin} and Huang, {Po Hsun} and Lin, {Shing Jong}",
year = "2017",
month = "7",
day = "1",
doi = "10.1210/jc.2016-3717",
language = "English",
volume = "102",
pages = "2373--2381",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "7",

}

TY - JOUR

T1 - Statin therapy reduces future risk of lower-limb amputation in patients with diabetes and peripheral artery disease

AU - Hsu, Chien Yi

AU - Chen, Yung Tai

AU - Su, Yu Wen

AU - Chang, Chun Chin

AU - Huang, Po Hsun

AU - Lin, Shing Jong

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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 lowerextremity 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], inhospital 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.

AB - 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 lowerextremity 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], inhospital 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.

UR - http://www.scopus.com/inward/record.url?scp=85023189437&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85023189437&partnerID=8YFLogxK

U2 - 10.1210/jc.2016-3717

DO - 10.1210/jc.2016-3717

M3 - Article

C2 - 28398564

AN - SCOPUS:85023189437

VL - 102

SP - 2373

EP - 2381

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 7

ER -