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Statins and/or fibrates for diabetic retinopathy: a systematic review and meta-analysis
Mozetic, Vânia; Pacheco, Rafael Leite; Latorraca, Carolina de Oliveira Cruz; Riera, Rachel.
Afiliación
  • Mozetic, Vânia; Instituto Dante Pazzanese de Cardiologia. Universidade Federal de São Paulo (Unifesp). Escola Paulista de Medicina (EPM). São Paulo. BR
  • Pacheco, Rafael Leite; Universidade Federal de São Paulo (Unifesp). Escola Paulista de Medicina (EPM). Centro Universitário São Camilo. São Paulo. BR
  • Latorraca, Carolina de Oliveira Cruz; Universidade Federal de São Paulo (Unifesp). Escola Paulista de Medicina (EPM). Centro Universitário São Camilo. São Paulo. BR
  • Riera, Rachel; Universidade Federal de São Paulo (Unifesp). Escola Paulista de Medicina (EPM). Hospital Sirio Libanês. São Paulo. BR
Diabetol. metab. syndr ; 00: 01-14, Nov. 2019. tabela, gráfico
Artículo en Inglés | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1025136
Biblioteca responsable: BR79.1
Ubicación: BR79.1
ABSTRACT
Abstract Evidence from observational studies have found a relationship between serum cholesterol and diabetic retinopathy (DR). Apart of the assumption that cholesterolemic control has benefits for patients with diabetes with or without retinopathy, the effects of lipid-lowering drugs have not been properly mapped and critically assessed so far. The objective of this study was to evaluate the effects of statins and/or fibrates on prevention and progression of DR. We conducted a Systematic review of randomized controlled trials (RCTs) following the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance to PRISMA Statement. GRADE approach was used to summarize the certainty of the evidence. Eight RCTs that fulfilled our eligibility criteria were included, assessing the effects of fibrates (n = 4), statins (n = 3) and fibrate plus statins (n = 1) for therapy (n = 8) or prevention (n = 4) of DR. Overall, the main concern regarding risk of bias assessment was due to incomplete outcome data because high rate of losses in five RCTs. Furthermore, the risk of reporting bias was rated unclear due the lack of previously published protocol in seven RCTs. Fibrates seemed to be associated with a 45% risk reduction of macular edema incidence (Relative Risk 0.55, 95% confidence interval of 0.38 to 0.81, 1309 participants, 2 RCTs, I2 = 0%, low certainty of the evidence). The certainty of evidence for other outcomes was also very low or low, and we are uncertain regarding the effects of fibrates for DR. Overall, adverse events seemed to be similar between fibrate and placebo, but again based on the width of the confidence intervals, an important increase of adverse events cannot be rule out. The combination statin/fibrate did not seem to have benefit for visual acuity but is likely that further studies can modify this estimate since the current evidence is limited. Adverse events and quality of life were not measured or reported. Concluding, this study found eight RCTs, with limited methodological quality, that assessed the effects of fibrates and/or statins for DR. Based on these findings, we are uncertain about the effects of statins for DR. Fibrates seemed to reduce the incidence of macular edema (low certainty evidence) without increase adverse events (low to very low certainty evidence). Number of Protocol registration PROSPERO CRD42016029746. (AU)
Asunto(s)

Texto completo: Disponible Colección: Bases de datos nacionales / Brasil Base de datos: Sec. Est. Saúde SP / SESSP-IDPCPROD Asunto principal: Metaanálisis / Inhibidores de Hidroximetilglutaril-CoA Reductasas / Retinopatía Diabética / Ácidos Fíbricos Tipo de estudio: Ensayo clínico controlado / Estudio de etiología / Guía de práctica clínica / Estudio observacional / Revisión sistemática Aspecto: Preferencia del paciente Idioma: Inglés Revista: Diabetol. metab. syndr Año: 2019 Tipo del documento: Artículo Institución/País de afiliación: Instituto Dante Pazzanese de Cardiologia/BR / Universidade Federal de São Paulo (Unifesp)/BR

Texto completo: Disponible Colección: Bases de datos nacionales / Brasil Base de datos: Sec. Est. Saúde SP / SESSP-IDPCPROD Asunto principal: Metaanálisis / Inhibidores de Hidroximetilglutaril-CoA Reductasas / Retinopatía Diabética / Ácidos Fíbricos Tipo de estudio: Ensayo clínico controlado / Estudio de etiología / Guía de práctica clínica / Estudio observacional / Revisión sistemática Aspecto: Preferencia del paciente Idioma: Inglés Revista: Diabetol. metab. syndr Año: 2019 Tipo del documento: Artículo Institución/País de afiliación: Instituto Dante Pazzanese de Cardiologia/BR / Universidade Federal de São Paulo (Unifesp)/BR
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