Abstract
Purpose :
The therapeutic efficacy of lipid-lowering agents (LLA) in preventing the progression and complications of diabetic retinopathy (DR) remains controversial, and research on more recently developed LLA, such as proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), in this context is particularly limited. To bridge this gap in current knowledge, this study retrospectively analyzed the electronic medical records to evaluate the associations between the use of various LLA and the risk of DR progression.
Methods :
Adults with type 2 diabetes mellitus and DR at a single United States institution were identified by the ICD-10 codes. Patients were divided into four cohorts based on the type of LLA they received: statin only (“statin” cohort), statin and fibrate (“fibrate” cohort), statin and PCSK9i (“PCSK9i” cohort), or none of the three agents (controls). To assess the adverse progression of DR, patients were monitored for the development of proliferative diabetic retinopathy (PDR), other complications of DR, and a need for pars plana vitrectomy, pan-retinal photocoagulation, or intravitreal injection therapy. After propensity score matching, cohorts were compared via Cox proportional hazards and logistic regression analyses to evaluate the rates and the risks of DR progression.
Results :
4,805 patients (mean age: 65.5±11.9 years, 49.0% female) were eligible for the analysis of the statin and fibrate cohorts, while 7,951 (mean age: 65.0±11.7 years, 48.2% female) were eligible for the analysis of the PCSK9i cohort. Compared to controls, patients in the statin cohort had a reduced rate of progression to PDR (HR:0.74, CI:0.65-0.85), although these cohorts did not significantly differ in their overall risk of developing PDR (RR:0.90, CI:0.59-1.39) or having a DR-related clinical event (RR:1.42, CI:0.97-2.10) by the end of the study. The addition of PCSK9i (RR:0.52, CI:0.33-0.84), but not fibrates (HR:0.91, CI:0.64-1.28), to statin therapy was associated with a reduced risk of having a DR-related clinical event.
Conclusions :
These results highlight the potential benefits of using statins in delaying the progression of DR to PDR and suggest that complementing statin therapy with PCSK9i may help prevent vision-impairing complications of DR. However, given the novel nature of PCSK9i, further research is needed to confirm the clinical efficacy of this combination in the management of DR.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.