Statins in Wound Care: A Case Study in Reviewing Literature
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by Aletha Tippett MD
Oh, what a shock to see a study published on atorvastatin treatment in the adult patients at risk of diabetic foot infection in a recent issue of Wounds.1 The conclusion of this study was that taking atorvastatin for at least three months reduced the risk of diabetic foot infections (DFI). The authors also theorized that statins could prevent infection in patients with diabetes.
Since this study was absolutely contradictory to what I have held about statins for my entire career, I read the article several times very carefully. In this study, the authors took two groups of patients. One group of patients with diabetes was admitted to the hospital with a DFI, and they subdivided this group into one taking atorvastatin, and one not taking atorvastatin.
The second group in this study was composed of outpatient individuals with diabetes who did not have a DFI, again subdivided into atorvastatin taking or not. The hospital group was called the experimental group. This group contained patients who had had diabetes a lot longer than the control group (the outpatient group without DFI) - 14 years versus 8 years, on average. The experimental group also had more smokers. The author did statistical analysis on the two groups, and evaluated the results of taking or not taking atorvastatin. Sixty-six percent of the control group took atorvastatin, while only 49% of the experimental group took atorvastatin.
Critique of the Study
This study, in my opinion, is a sham of science—nothing was really done to study. Two totally different patient groups were selected and compared. My reaction is: “so what?” This doesn’t mean anything, and I think the conclusions drawn are irrelevant. The problem is that statins will be touted as preventing and treating infection. In my published report on treating peripheral neuropathy, 100% of patients stopping statin therapy had improvement in their neuropathy symptoms.2 That is not related to infection, but relates to statin side-effects that can be very pronounced (not rare, as stated in this article).
My word to the wise is: be careful about what you read, and read everything critically.
References:
1. Nassaji M, Ghorbani R, Saboori Shkofte H. Previous Atorvastatin Treatment and Risk of Diabetic Foot Infection in Adult Patients: A Case-control Study.
Wounds. 2017 Jul;29(7):196-201. Epub 2017 Apr 27.
2. Tippett AW. Treating Peripheral Neuropathy. Wounds 2014; 26(3); 65-71.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
Comments
Agreeing wholeheartedly
Bravo, Dr. Tippett! I am very grateful that you took the time to address this article. I am saddened at how often peer reviewers do not catch such inconsistencies. Here is a referenced section, from my upcoming evidence-based clinical education booklet on preventing and managing diabetic foot ulcers and arterial wounds, describing how medications such as statins influence neuropathy:
"Patients with impaired glucose tolerance may experience a reversal of their neuropathy and avoid developing diabetes if they adhere to a program of diet and exercise.[1] The use of fibrates, even in patients without abnormal cholesterol levels, can also help prevent or even reduce symptoms of neuropathy.[2,3] Long-term statin use (>2 years) significantly increases the risk of developing atypical peripheral neuropathy, which is sometimes reversible when statin use is discontinued.[4,5] Prolonged metformin use often depletes vitamin B12 levels.[6] Targeted correction of any deficiency in vitamin D or B12 can help prevent neuropathy.[7] If the cause of the neuropathy is a low vitamin level, restoring B12 to normal may reverse some of the neuropathy and can arrest its progression.[1,6]"
Sincerely,
Linda Benskin, PhD, RN, SRN (Ghana), CWCN
Independent Nurse Researcher for rural areas of tropical developing countries and
Clinical Research and Education Liaison, & Charity Liaison, for Ferris Mfg. Corp.
References:
1. Callaghan B, McCammon R, Kerber K, Xu X, Langa KM, Feldman E. Tests and expenditures in the initial evaluation of peripheral neuropathy. Arch Intern Med. 2012 Jan 23;172(2):127–32.
2. Antonoglou C, Papanas N, Maltezos E. Lipid-lowering therapy in the diabetic foot: seeing the whole iceberg and not just the tip. Curr Vasc Pharmacol. 2014;12(5):745–50.
3. Othman A, Benghozi R, Alecu I, Wei Y, Niesor E, von Eckardstein A, et al. Fenofibrate lowers atypical sphingolipids in plasma of dyslipidemic patients: A novel approach for treating diabetic neuropathy? J Clin Lipidol. 2015 Aug;9(4):568–75.
4. Lei Q, Peng WN, You H, Hu ZP, Lu W. Statins in nervous system associated diseases: angels or devils? Pharmazie. 2014 Jun;69(6):448–54.
5. Grover HS, Luthra S, Maroo S. Are statins really wonder drugs? Journal of the Formosan Medical Association. 2014 Dec 1;113(12):892–8.
6. Bell DSH. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. South Med J. 2010 Mar;103(3):265–7.
7. Crawford PE, Fields-Varnado M. Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary. J Wound Ostomy Continence Nurs. 2013 Feb;40(1):34–45.
statins
Thank you Linda for your comments. I'm very happy to see others looking for the truth.
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