Trial reportJournal of vascular surgery2013
Statin use and lower extremity amputation risk in nonelderly diabetic patients.
Trial report in Journal of vascular surgery, 2013. The graph read 2 numbers from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. Cited by 16 papers.
What it found
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Read, but not usablea number the graph found but could not read as for or against
Compared with patients who did not use cholesterol-lowering agents, statin users were 35% to 43% less likely to experience an LEA (HR, 0.65; 95% confidence interval [CI], 0.42-0.99) and a treatment failure (HR, 0.57; 95% CI, 0.54-0.60).
Compared with patients who did not use cholesterol-lowering agents, statin users were 35% to 43% less likely to experience an LEA (HR, 0.65; 95% confidence interval [CI], 0.42-0.99) and a treatment failure (HR, 0.57; 95% CI, 0.54-0.60).
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Statins×lipids
No readable resultOpen on the map →What to test next →38 readable studies in this cell: 27 favour the treatment, 5 find no difference, 6 favour the comparator.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 50 citations in OpenAlex.
- Disparities in Antidiabetic Medication Discontinuation Between Non-Hispanic White and Black Beneficiaries in Medicare Across Diabetes Belt and Surrounding Area.Journal of racial and ethnic health disparities · 2026Article
- The impact of statin therapy on the healing of diabetic foot ulcers: a case-control series.Clinical diabetes and endocrinology · 2024Article
- Association of Statin Therapy With Major Adverse Cardiovascular and Limb Outcomes in Patients With End-stage Kidney Disease and Peripheral Artery Disease Receiving Maintenance Dialysis.JAMA network open · 2022Article
- Role of Lipid-Lowering Therapy in Peripheral Artery Disease.Journal of clinical medicine · 2022Review
- Peripheral vascular remodeling during ischemia.Frontiers in pharmacology · 2022Review
- Comprehensive Assessment of Current Management Strategies for Patients With Diabetes and Chronic Limb-Threatening Ischemia.Clinical diabetes : a publication of the American Diabetes Association · 2021Article
- Associations between attainment of incentivized primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study.BMJ open diabetes research & care · 2021Article
- Statins and Peripheral Arterial Disease: A Narrative Review.Frontiers in cardiovascular medicine · 2021Review
- Long-Term Effectiveness and Safety of Initiating Statin Therapy After Index Revascularization In Patients With Peripheral Arterial Occlusive Disease.Journal of the American Heart Association · 2020Article
- Diagnosing and managing diabetic somatic and autonomic neuropathy.Therapeutic advances in endocrinology and metabolism · 2019Review
- An update on the diagnosis and treatment of diabetic somatic and autonomic neuropathy.F1000Research · 2019Review
- Longitudinal trends and predictors of statin use among patients with diabetes.Journal of diabetes and its complications · 2018Article
- Article
- Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.Journal of diabetes and its complications · 2017Article
- The Metabolic Syndrome and Microvascular Complications in a Murine Model of Type 2 Diabetes.Diabetes · 2015Article
- Effect of rosuvastatin on diabetic polyneuropathy: a randomized, double-blind, placebo-controlled Phase IIa study.Diabetes, metabolic syndrome and obesity : targets and therapy · 2014Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
The marked sentences are the ones the graph read a number from.
objectiveTo examine the association between use of statin and nonstatin cholesterol-lowering medications and risk of nontraumatic major lower extremity amputations (LEAs) and treatment failure (LEA or death).
methodsA retrospective cohort of patients with Type I and Type 2 diabetes mellitus (diabetes) was followed for 5 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, peripheral artery disease, 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 (HRs) were estimated. The study took place in the U.S. Department of Veterans Affairs Healthcare system, and the subjects consisted of cholesterol drug-naïve patients with Type I or II diabetes who were treated in the U.S. Department of Veterans Affairs Healthcare system in 2003 and were <65 years old at the end of follow-up.
resultsOf 83,953 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 with patients who did not use cholesterol-lowering agents, statin users were 35% to 43% less likely to experience an LEA (HR, 0.65; 95% confidence interval [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).
conclusionsThis is the first study to report a significant association between statin use and diminished amputation risk among patients with diabetes. In this nonrandomized cohort, beneficial effects of statin therapy were similar to that seen in large-scale clinical trial experience. For LEA risk, those given nonstatins did not have a statistically significant benefit and its effect on LEA risk was much smaller compared with statins. Unanswered questions to be explored in future studies include a comparison of statins of moderate vs 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.