Does cholesterol-lowering intensify neuropathy in T2D?

  • JAMA Netw Open

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with type 2 diabetes (T2D) and distal symmetric diabetic polyneuropathy (DPN), low total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels are associated with more nerve lesions, impaired nerve conduction, and greater symptom severity.

Why this matters

  • DPN is a severe diabetes complication.
  • Cholesterol-lowering is recommended in T2D management.

Study design

  • Single-center, prospective cohort study of 100 participants with T2D (64 with DPN, 36 without).
  • All underwent right leg magnetic resonance neurography.
  • Funding: German Research Foundation.

Key results

  • TC was positively correlated with tibial nerve conduction velocity (NCV; P=.02), peroneal NCV (P=.03), and tibial nerve compound muscle action potential (CMAP; P=.01).
  • LDL-C was also positively correlated with each of these (P=.04, .02, and .001, respectively), but high-density lipoprotein cholesterol (HDL-C) was not.
  • Increase in T2wFS-hypointense lipid equivalent lesion (LEL) load was negatively associated with NCVs of tibial (P=.01) and peroneal nerves (P<.001 and with cmaps of tibial peroneal nerves>
  • Negative correlations between LEL load and: 
    • TC (P<.001>
    • HDL-C (P=.006), and
    • LDL-C (P=.003).
  • Positive correlations between LEL load and:
    • neuropathy disability score (P=.005),
    • neuropathy symptom score (P=.03),
    • mean tibial nerve cross-sectional area (P<.001 and>
    • mean maximum lesion length (P<.001>

Limitations

  • Cross-sectional data.
  • Small sample size.