Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2017; 8(1): 1-6
Published online Jan 15, 2017. doi: 10.4239/wjd.v8.i1.1
Role of lipid-lowering agents in the management of diabetic retinopathy
Estelle Ioannidou, Vasilis-Spyridon Tseriotis, Konstantinos Tziomalos
Estelle Ioannidou, Vasilis-Spyridon Tseriotis, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
Author contributions: Ioannidou E and Tseriotis VS drafted the editorial; Tziomalos K critically revised the draft.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Tziomalos, MD, PhD, Assistant Professor of Internal Medicine, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636 Thessaloniki, Greece. ktziomalos@yahoo.com
Telephone: +30-2310-994621 Fax: +30-2310-994773
Received: August 13, 2016
Peer-review started: August 16, 2016
First decision: September 2, 2016
Revised: September 17, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: January 15, 2017
Processing time: 145 Days and 14.3 Hours
Abstract

Diabetic retinopathy affects a substantial proportion of patients with diabetes mellitus (DM) and is the leading cause of blindness in working-aged adults. Even though the incidence of diabetic retinopathy has declined in the last decades, its prevalence increased and is expected to rise further as a result of the increasing incidence of type 2 DM (T2DM) and the longer life expectancy of patients with DM. The pathogenesis of diabetic retinopathy is multifactorial. Some observational studies suggested an association between dyslipidemia and the development and progression of retinopathy in patients with DM but others did not confirm this association. Regarding lipid-lowering agents, studies that evaluated the role of statins in the management of these patients are mostly small and yielded discrepant results. Large randomized studies with statins in patients with T2DM showed no benefit of these agents on diabetic retinopathy but were not designed to address this effect. In contrast, both preclinical data and two large randomized controlled studies, the FIELD and the ACCORD trial, showed that fenofibrate delays the progression of diabetic retinopathy. Even though the mechanisms underpinning this favorable effect are not entirely clear, these findings suggest that fenofibrate might represent a useful tool for the management of diabetic retinopathy.

Keywords: Diabetes mellitus; Lipid-lowering agents; Statins; Fibrates; Ezetimibe; Colesevelam; Retinopathy

Core tip: Even though it is unclear whether dyslipidemia is implicated in the pathogenesis of diabetic retinopathy, both preclinical data and two large randomized controlled studies showed that treatment with fenofibrate delays the progression of diabetic retinopathy. In contrast, statins do not appear to play a role in the management of this complication despite the promising findings of animal studies.