Lipid-lowering Therapy in the Diabetic Foot: Seeing the Whole Iceberg and not Just the Tip

Diabetic foot ulcers arise from neuropathy and/or ischaemia. The diabetic foot is associated with cardiovascular disease (CVD) and excess mortality. Lipid-lowering therapy reduces CVD morbidity and mortality in diabetic patients with foot ulcers. In particular, statins decrease CVD mortality and improve survival in diabetic foot patients, while fibrates benefit patients with a specific lipid profile. Statins reduce progression of the local disease, improving symptoms and reducing amputations, mainly due to their impact on peripheral arterial disease. Fibrates appear to reduce amputations by improving neuropathy. They also improve ulcer healing and reduce recurrence. This review assesses the role of hypolipidaemic treatment in diabetic foot patients.