Statins in Diabetic Foot Ulcer Healing: From Biological Mechanisms to Clinical Evidence. A Comprehensive Literature Review

Diabetic foot ulcers (DFUs) are a serious complication of diabetes mellitus. Statins are widely used for treatment of dyslipidaemia and prevention of cardiovascular events. They also exert multiple pleiotropic effects, including improvement of endothelial function, and promotion of angiogenesis and tissue repair. Accumulating evidence suggests that these properties may be beneficial in diabetic wound healing. The aim of this comprehensive review was to summarise preclinical and clinical data regarding the potential role of statins in DFUs management. Experimental studies consistently demonstrated that statins promote wound healing through several mechanisms, including increased nitric oxide bioavailability, vascular endothelial growth factor (VEGF)-mediated angiogenesis, improved endothelial function, and increased collagen synthesis and deposition. Emerging drug-delivery strategies, including topical formulations and tissue-engineered scaffolds, further improved therapeutic efficacy. Clinical evidence remains limited but encouraging. Observational studies have reported inconsistent findings, whereas randomised controlled trials suggest that statins may reduce ulcer recurrence and accelerate wound healing without significant safety concerns. Overall, the evidence supports a strong biological rationale for the use of statins as adjunctive therapy in DFUs. However, further research is required to establish their clinical efficacy, dosage, route of administration and treatment duration.