Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Relation between lipid profile, blood pressure and retinopathy in diabetic patients in King Abdulaziz University hospital: a retrospective record review study

Relation between lipid profile, blood pressure and retinopathy in diabetic patients in King... Background: Diabetic retinopathy (DR) is a major cause of blindness worldwide, threatening the vision of approxi- mately 10% of patients with diabetes. Many studies have demonstrated that intensive control of the risk factors for DR is essential to reduce the onset and progression of DR. Currently, the relationship between lipid profile and DR is still unclear, especially in Saudi Arabia. We aimed to assess the correlation between both the development and severity of DR with lipid profile and blood pressure among the diabetic patients at the King Abdul-Aziz University hospital in Jeddah, Saudi Arabia. Methods: This was a retrospective record review study of 298 diabetic patients diagnosed with DR. Retinal findings were correlated to serum lipids levels using univariate, bivariate, and multivariate analysis. Results: This study included 298 participants with DR. Triglyceride levels, systolic blood pressure, low-density lipopro- tein cholesterol levels, and presence of macular edema were significantly associated with DR progression (P = 0.012, P = 0.001, P = 0.002). Other parameters, including total cholesterol, high-density lipoprotein cholesterol, HbA1C, body mass index, age, were not significantly associated with DR. Conclusion: Elevation in serum triglyceride levels and systolic blood pressure showed a statically significant associa- tion with diabetic retinopathy. Controlling these factors may help preventing progression and occurrence of diabetic retinopathy among diabetic patients. Keywords: Diabetic retinopathy, Retinopathy, Lipid profile, DR, Lipid effect complications and morbidity increase, the DR prevalence Introduction is predicted to reach 5.4% by 2025 [3]. Identifying and Diabetic retinopathy (DR) is a microvascular complica- controlling the risk factors for DR is essential to reduce tion of diabetes mellitus (DM) that is an important cause the onset and progression of DR [4]. Several risk factors of visual impairment in adults, threatening the vision for DR have been identified, including the duration of of approximately 10% of patients with diabetes [1, 2]. DM, glucose level, and blood pressure [5]. Moreover, it Therefore, DR is a growing concern worldwide. As DM has been suggested that patients’ lipid status also affects the onset and pathogenesis of DR [6]. Diabetic retinopa- *Correspondence: Dr.dania2030@gmail.com thy can be categorized into non-proliferative diabetic Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Alattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 2 of 5 retinopathy (NPDR) and proliferative diabetic retinopa- Committee of King Abdulaziz University (KAU) (538- thy (PDR) based on its stage and severity [7, 8]. 20). The medical records of 289 diabetic patients with Previous studies have reported conflicting results retinopathy were reviewed. The severity of DR was clas - regarding the effect of serum lipids on the onset and pro - sified into mild non-proliferative DR (NPDR), moder - gression of DR [9]. Dyslipidemia associated with diabetes ate NPDR, severe NPDR, and PDR, according to the is characterized by high serum levels of total cholesterol ETDRS grading scale [14]. Patients aged 18  years and (TC), triglycerides (TG), low-density lipoprotein choles- above with known type 1 or type 2 diabetes mellitus and terol (LDL-C), and high-density lipoprotein cholesterol diagnosed with DR were included. Patients with a recent (HDL-C), and these are proposed to represent possible eye infection, who had undergone any ocular surgery markers for DR progression and the occurrence of dia- within the previous 6  months, or those who were preg- betic macular edema (DME) [9]. nant were excluded. Demographic data, such as age, Several studies have been conducted to identify fac- gender, and nationality were collected from the medi- tors associated with DR progression. A previous study of cal records. Moreover, we also collected clinical data, 140 patients with type 2 diabetes has conducted to deter- such as systolic blood pressure; diastolic blood pressure; mine the correlation between the severity of DR, and Hba1C; and lipid profile, including TC, TG, low-density serum lipid and other modifiable risk factors found that lipoprotein (LDL), high-density lipoprotein (HDL), and high cholesterol level, blood pressure, renal function, and creatinine levels. Triglycerides and cholesterol classifica - urine albumin excretion are significantly associated with tion were according to The National Cholesterol Educa - the progression of DR, while there was no significant tion Program Adult Treatment Panel III guidelines [15]. association between HbA1c and DR [10]. In addition, the Body mass index (BMI) was calculated for each patient Chennai Urban Rural Epidemiological Study by Rema using the BMI formula (weight in kg divided by height in et al. which included 1763 Indian type 2 diabetic subjects meters squared). The primary outcome was the relation - suggested that serum triglycerides are associated with ship between lipid profile, blood pressure, and DR. eGFR the risk of DR, while LDL-C was associated with DME calculated using the 2009 CKD-EPI creatinine equation. [11]. Regarding other risk factors for DR, Antonetti et al. Data were registered using online Google Forms and described the effect of arteriolar dysfunction and hemo - entered in Microsoft Excel 2016, and statistical analysis dynamic alterations on late-stage microvascular disease was performed using Statistical Package for the Social and vision loss [12]. Science (SPSS) version 21. Means and standard devia- In contrast, a meta-analysis conducted in 2017 tions were calculated to describe continuous variables, included seven studies that did not find apparent differ - whereas numbers and percentages were used for cate- ences in TG, TC, and HDL-C levels between patients gorical variables. Student’s t-test and chi-square test were with and without DR [3]. Further, a retrospective study used to evaluate the differences between categorical vari - that included 191 Japanese participants found no sig- ables. Statistical significance was set at p < 0.05. Quantita- nificant correlation between serum lipid levels with the tive data were presented as mean and standard deviation severity of DR or existence of macular edema despite (mean ± SD), where one-way ANOVA and Kruskal Wallis the significant correlation between the blood glucose, tests were applied according to data normality. HbA1c, and total cholesterol [13]. Multiple logistic regression analysis was performed Although several studies have been conducted on this with DR stage as the dependent variable. topic, the relationship between lipid profile, blood pres - sure, and DR is still unclear, especially in Saudi Arabia. In particular, there are limited studies which have focused Results on the role of lipids as a risk factor for DR. To this end, The study included 165 women (57.1%) and 124 men our study aimed to assess the correlation between both (42.9%). Ninety-six (33.2%) patients had mild NPDR, 103 lipid profile and blood pressure and the development (35.6%) had moderate NPDR, 29 (10%) had severe NPDR, and severity of DR among diabetic patients at the King and 61 (21.1%) had PDR. Abdul-Aziz University Hospital in Jeddah, Saudi Arabia Triglyceride levels were significantly associated with in 2021. the severity of DR; patients with PDR showed signifi - cantly higher TG levels than NPDR patients (P = 0.012). Patients with advanced DR stage showed higher LDL Methodology levels (Table  1). There was no significant relationship This retrospective record review study was conducted in between the progression of DR and cholesterol, DBP, the Department of Ophthalmology at the King Abdul- and HBa1C (P = 0.231, P = 0.256, P = 0.197, respectively) Aziz University Hospital in Jeddah, Saudi Arabia, in June (Table 1). 2021. The study was approved by the Research Ethics A lattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 3 of 5 Table 1 Clinical characteristic of different stages of diabetic retionpathy Mild DR Moderate DR Severe DR PDR P value N = 96 N = 103 N = 29 N = 61 Age 61.25 ± 13.56 62.52 ± 11.34 61.72 ± 9.03 57.92 ± 12.49 0.132* BMI 30.26 ± 6.65 31.89 ± 5.94 31.71 ± 5.30 30.88 ± 6.18 0.285* cholesterol 4.67 ± 1.01 4.85 ± 1.12 5.43 ± 1.41 13.1 ± 60.2 0.231* triglycerides 1.61 ± 0.78 1.88 ± 1.09 1.94 ± 1.11 2.23 ± 1.58 0.012* LDL 2.97 ± 1.02 3.06 ± 0.93 3.61 ± 1.21 3.45 ± 1.08 0.005* HDL 1.28 ± 0.40 1.24 ± 0.51 1.15 ± 0.28 1.29 ± 0.771* 0.85 creatinine 87.68 ± 51.16 83.19 ± 28.76 111.41 ± 149.03 117.83 ± 89.69 0.009* SBP 139.46 ± 16.58 142.66 ± 17.81 151.03 ± 19.66 149.39 ± 18.30 0.001* DBP 73.03 ± 9.97 73.36 ± 10.82 76.98 ± 10.78 75.17 ± 11.98 0.256* HBA1C 8.84 ± 1.62 9.09 ± 1.89 9.25 ± 0.187 9.51 ± 2.38 0.197* *One-way ANOVA Table 2 Multinominal logistic regression analysis the mean GFR, and a high mean creatinine level were risk independent predictors (risk factors) of advanced DR staging factors for advanced DR stage (p ≤ 0.05). Other lipid marker analyses are presented in Table  3. Variable Likelihood ratio Chi-square df p-value Patients with severe NPDR had significantly higher mean Age 461.8 6.54 3 0.088 LDL values than those with other DR stages (p = 0.005). Gender 464.1 8.84 3 0.031 However, a non-significant relationship was found Nationality 458.28 3.03 3 0.388 between the DR stage and HDL (P = 0.534). Macular edema 462.61 7.35 3 0.061 SBPM 456.81 1.55 3 0.669 Discussion DBPM 457.58 2.32 3 0.508 The reported prevalence of DR in Saudi Arabia in 2019 Cholesterol 458.23 2.97 3 0.395 was 33.7% [16]. Diabetes and its complications pose a Cholesterol categories 458.85 3.58 3 0.309 significant personal and public health burden; therefore, Triglycerides 465.02 9.76 3 0.021 identifying and modifying the risk factors for diabetes Triglyceride categories 464.62 9.36 3 0.025 is an important clinical goal. Numerous studies have GFR 473.01 17.75 3 < 0.001 found a correlation between lipid fractions and macro- Creatinine 465.01 7.95 3 0.021 vascular complications of diabetes (e.g., coronary artery HbA1c 455.67 0.41 3 0.938 disease) [17]. However, very few studies have focused on BMI 455.8 0.54 3 0.909 the association between serum lipids and microvascular BMI categories 457.03 1.77 3 0.62 complications such as DR. Our study aimed to assess the association between DR severity, lipid profile, and blood pressure among diabetic patients at the King Abdul-Aziz In our analysis, we found that as SBP increased, the University Hospital in Jeddah. severity of DR also increased (P = 0.001) (Table 1). There Our analysis showed a significant relationship between was no association between DR stage and creatinine TG levels and DR severity, which is comparable to find - level (P = 0.165). Table  2 shows the results of multino- ings reported in India which showed a strong positive mial logistic regression analysis to assess the independent relationship between TG and DR stage [10]. The role of predictors of DR stage. High TG, high TG category, low serum lipids in the development and progression of DR Table 3 Relationship between DR stage and HDL and LDL Variable Mild NPDR Moderate NPDR sever NPDR PDR Test p-value Mean ± SD Mean ± SD Mean ± SD Mean ± SD HDL 1.27 ± 0.39 1.24 ± 0.51 1.15 ± 0.28 1.29 ± 0.84 3* 0.534 LDL 2.97 ± 1.02 3.05 ± 0.93 3.6 ± 1.21 3.44 ± 1.07 4.44** 0.005 N.B.: * Kruskal Wallis test **One Way ANOVA test Alattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 4 of 5 has been evaluated worldwide; hyperlipidemia causes importance of measuring lipid levels and blood pressure endothelial dysfunction due to reduced bioavailability of in patients with diabetes to initiate appropriate treat- nitric oxide and breakdown of the blood retinal barrier, ments and prevent the onset and progression of diabetic which leads to exudation of serum lipids and lipopro- retinopathy and DME. teins, resulting in DR changes [9]. Acknowledgements Other studies have also investigated the relationship We would like to thank Editage (www. edita ge. com) for English language between DR and other lipid parameters. Unlike previ- editing. ous studies which demonstrated an association between Authors’ contributions cholesterol and DR [10], we found no significant associa - We confirm that there are no other persons who satisfied the criteria for tion between serum cholesterol and HDL with DR stage. authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. All authors have read Our observations that there was no association between and approved the final manuscript. DR stage and cholesterol and HDL were consistent with those of previous reports from Turkey and India [13, 18] Funding Not applicable. and those of the WESDR study [19]. This observation is consistent with the mechanism of DR progression which Availability of data and materials is thought to be related to intraretinal lipid transporta- Raw data were generated at King Abdul-Aziz University Hospital.Derived data supporting the findings of this study are available from the corresponding tion, rather than serum lipid levels per se [13]. author D. W. A. on request. In our study, systolic blood pressure was associated with the presence and severity of DR. This result was Declarations consistent with the results of previous studies [5, 10, 20]. Hypertensive patients had a more than two-fold risk of Ethics approval and consent to participate The study was approved by the Research Ethics Committee of King Abdulaziz DR compared to diabetic patients with controlled blood University (KAU) (538–20). There was no participation required. pressure. This may be because the endothelium of the retinal capillaries is injured in DR, and hypertension pro- Consent for publication I, the corresponding author, give my consent for the publication of informa- motes endothelial disturbance [5]. tion, which can include to be published in the International Journal of Retina This study has some limitations worth noting. First, and Vitreous. this was single-center study and therefore further studies Competing interests are warranted to confirm whether the results are translat - Not applicable. able to other healthcare settings. Second, the difference in time of laboratory readings could influence the results. Author details Department of Ophthalmology, College of Medicine, King Abdulaziz Uni- Therefore, further prospective studies are warranted to versity Hospital, Jedddah, Saudi Arabia. Faculty of Medicine, King Abdulaziz validate our results. Also, the small sample size due to University, Jeddah, Saudi Arabia. single-center data consider an important limitation to Received: 25 October 2021 Accepted: 20 February 2022 mention and the number of included participants could be greater. Nevertheless, the results described herein are valuable as this is one of the first studies conducted to assess the correlation between both causation and sever- References ity of DR with lipid profile levels and blood pressure in 1. Lim LS, Wong TY. Lipids and diabetic retinopathy. Expert Opin Biol Ther. Saudi Arabia. 2012;12(1):93–105. 2. Jeng CJ, Hsieh Y T, Yang CM, Yang CH, Lin CL, Wang IJ. Diabetic retin- opathy in patients with dyslipidemia: development and progression. Conclusion Ophthalmol Retina. 2018;2(1):38–45. 3. Zhou Y, Wang C, Shi K, Yin X. Relationship between dyslipidemia and In conclusion, our findings have clear clinical impli - diabetic retinopathy: a systematic review and meta-analysis. Medicine cations. The association of serum lipids, particularly (Baltimore). 2018;97(36): e12283. triglyceride levels, with DR severity and progression sug- 4. Landmesser U, Hornig B, Drexler H. Endothelial dysfunction in hyper- cholesterolemia: mechanisms, pathophysiological importance, and gests that hyperlipidemia may have an impact on DR, therapeutic interventions. Semin Thromb Hemost. 2000;26(5):529–37. despite the lack of association with other lipid param- 5. Wat N, Wong RL, Wong IY. Associations between diabetic retinopathy and eters such as cholesterol and HDL. We also found that systemic risk factors. Hong Kong Med J. 2016;22(6):589–99. 6. Sjølie AK, Stephenson J, Aldington S, Kohner E, Janka H, Stevens L, systolic blood pressure was associated with DR pro- et al. Retinopathy and vision loss in insulin-dependent diabetes in gression. These observations help to clarify some of the Europe, The EURODIAB IDDM Complications Study. Ophthalmology. discrepancies of previous studies and suggest that lipid- 1997;104(2):252–60. 7. Modjtahedi BS, Bose N, Papakostas TD, Morse L, Vavvas DG, Kishan AU. targeting therapies may be more effective in slowing the Lipids and diabetic retinopathy. Semin Ophthalmol. 2016;31(1–2):10–8. progression of DR than in preventing the development of 8. Wang W, Lo ACY. Diabetic retinopathy: pathophysiology and treatments. DR per se. Taken together, these results demonstrate the Int J Mol Sci. 2018. https:// doi. org/ 10. 3390/ ijms1 90618 16. A lattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 5 of 5 9. Shermin S, Mollah FH, Hoque MM, Arslan MI, Rahman MR. Serum lipids and diabetic retinopathy in newly diagnosed type 2 diabetic subjects. J Enam Med Col. 2012;1(2):63–6. 10. Agroiya P, Philip R, Saran S, Gutch M, Tyagi R, Gupta KK. Association of serum lipids with diabetic retinopathy in type 2 diabetes. Indian J Endo- crinol Metab. 2013;17(Suppl 1):S335–7. 11. Rema M, Srivastava BK, Anitha B, Deepa R, Mohan V. Association of serum lipids with diabetic retinopathy in urban South Indians–the Chennai Urban Rural Epidemiology Study (CURES) Eye Study–2. Diabet Med. 2006;23(9):1029–36. 12. Antonetti DA, Barber AJ, Bronson SK, Freeman WM, Gardner TW, Jefferson LS, et al. Diabetic retinopathy: seeing beyond glucose-induced microvas- cular disease. Diabetes. 2006;55(9):2401–11. 13. Cetin EN, Bulgu Y, Ozdemir S, Topsakal S, Akın F, Aybek H, et al. Associa- tion of serum lipid levels with diabetic retinopathy. Int J Ophthalmol. 2013;6(3):346–9. 14. ETDRS Research Group. Early treatment diabetic retinopathy study design and baseline patient characteristics, ETDRS report number 7. Ophthal- mology. 1991;98(5 Suppl):741–56. 15. Lipsy RJ. The national cholesterol education program adult treatment panel III guidelines. J Manag Care Pharm. 2003;9(1 Suppl):2–5. 16. Yasir ZH, Hassan AD, Rajiv K. Diabetic retinopathy (DR) among 40 years and older Saudi population with diabetes in Riyadh governo- rate, Saudi Arabia—a population based survey. Saudi J Ophthalmol. 2019;33(4):363–8. 17. Moosaie F, Firouzabadi FD, Abouhamzeh K, Esteghamati S, Meysamie A, Rabizadeh S, et al. Lp(a) and Apo-lipoproteins as predictors for micro- and macrovascular complications of diabetes: a case-cohort study. Nutr Metab Cardiovasc Dis. 2020;30(10):1723–31. 18. Idiculla J, Nithyanandam S, Joseph M, Mohan VA, Vasu U, Sadiq M. Serum lipids and diabetic retinopathy: a cross-sectional study. Indian J Endo- crinol Metab. 2012;16(Suppl 2):S492–4. 19. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The wisconsin epidemio- logic study of diabetic retinopathy, VII. Diabetic nonproliferative retinal lesions. Ophthalmology. 1987;94(11):1389–400. 20. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–64. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? Choose BMC and benefit from om: : fast, convenient online submission thorough peer review by experienced researchers in your field rapid publication on acceptance support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year At BMC, research is always in progress. Learn more biomedcentral.com/submissions http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Retina and Vitreous Springer Journals

Relation between lipid profile, blood pressure and retinopathy in diabetic patients in King Abdulaziz University hospital: a retrospective record review study

Download PDF
5 pages

Loading next page...
 
/lp/springer-journals/relation-between-lipid-profile-blood-pressure-and-retinopathy-in-4NVgDwEN08

References (25)

Publisher
Springer Journals
Copyright
Copyright © The Author(s) 2022
eISSN
2056-9920
DOI
10.1186/s40942-022-00366-4
Publisher site
See Article on Publisher Site

Abstract

Background: Diabetic retinopathy (DR) is a major cause of blindness worldwide, threatening the vision of approxi- mately 10% of patients with diabetes. Many studies have demonstrated that intensive control of the risk factors for DR is essential to reduce the onset and progression of DR. Currently, the relationship between lipid profile and DR is still unclear, especially in Saudi Arabia. We aimed to assess the correlation between both the development and severity of DR with lipid profile and blood pressure among the diabetic patients at the King Abdul-Aziz University hospital in Jeddah, Saudi Arabia. Methods: This was a retrospective record review study of 298 diabetic patients diagnosed with DR. Retinal findings were correlated to serum lipids levels using univariate, bivariate, and multivariate analysis. Results: This study included 298 participants with DR. Triglyceride levels, systolic blood pressure, low-density lipopro- tein cholesterol levels, and presence of macular edema were significantly associated with DR progression (P = 0.012, P = 0.001, P = 0.002). Other parameters, including total cholesterol, high-density lipoprotein cholesterol, HbA1C, body mass index, age, were not significantly associated with DR. Conclusion: Elevation in serum triglyceride levels and systolic blood pressure showed a statically significant associa- tion with diabetic retinopathy. Controlling these factors may help preventing progression and occurrence of diabetic retinopathy among diabetic patients. Keywords: Diabetic retinopathy, Retinopathy, Lipid profile, DR, Lipid effect complications and morbidity increase, the DR prevalence Introduction is predicted to reach 5.4% by 2025 [3]. Identifying and Diabetic retinopathy (DR) is a microvascular complica- controlling the risk factors for DR is essential to reduce tion of diabetes mellitus (DM) that is an important cause the onset and progression of DR [4]. Several risk factors of visual impairment in adults, threatening the vision for DR have been identified, including the duration of of approximately 10% of patients with diabetes [1, 2]. DM, glucose level, and blood pressure [5]. Moreover, it Therefore, DR is a growing concern worldwide. As DM has been suggested that patients’ lipid status also affects the onset and pathogenesis of DR [6]. Diabetic retinopa- *Correspondence: Dr.dania2030@gmail.com thy can be categorized into non-proliferative diabetic Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Alattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 2 of 5 retinopathy (NPDR) and proliferative diabetic retinopa- Committee of King Abdulaziz University (KAU) (538- thy (PDR) based on its stage and severity [7, 8]. 20). The medical records of 289 diabetic patients with Previous studies have reported conflicting results retinopathy were reviewed. The severity of DR was clas - regarding the effect of serum lipids on the onset and pro - sified into mild non-proliferative DR (NPDR), moder - gression of DR [9]. Dyslipidemia associated with diabetes ate NPDR, severe NPDR, and PDR, according to the is characterized by high serum levels of total cholesterol ETDRS grading scale [14]. Patients aged 18  years and (TC), triglycerides (TG), low-density lipoprotein choles- above with known type 1 or type 2 diabetes mellitus and terol (LDL-C), and high-density lipoprotein cholesterol diagnosed with DR were included. Patients with a recent (HDL-C), and these are proposed to represent possible eye infection, who had undergone any ocular surgery markers for DR progression and the occurrence of dia- within the previous 6  months, or those who were preg- betic macular edema (DME) [9]. nant were excluded. Demographic data, such as age, Several studies have been conducted to identify fac- gender, and nationality were collected from the medi- tors associated with DR progression. A previous study of cal records. Moreover, we also collected clinical data, 140 patients with type 2 diabetes has conducted to deter- such as systolic blood pressure; diastolic blood pressure; mine the correlation between the severity of DR, and Hba1C; and lipid profile, including TC, TG, low-density serum lipid and other modifiable risk factors found that lipoprotein (LDL), high-density lipoprotein (HDL), and high cholesterol level, blood pressure, renal function, and creatinine levels. Triglycerides and cholesterol classifica - urine albumin excretion are significantly associated with tion were according to The National Cholesterol Educa - the progression of DR, while there was no significant tion Program Adult Treatment Panel III guidelines [15]. association between HbA1c and DR [10]. In addition, the Body mass index (BMI) was calculated for each patient Chennai Urban Rural Epidemiological Study by Rema using the BMI formula (weight in kg divided by height in et al. which included 1763 Indian type 2 diabetic subjects meters squared). The primary outcome was the relation - suggested that serum triglycerides are associated with ship between lipid profile, blood pressure, and DR. eGFR the risk of DR, while LDL-C was associated with DME calculated using the 2009 CKD-EPI creatinine equation. [11]. Regarding other risk factors for DR, Antonetti et al. Data were registered using online Google Forms and described the effect of arteriolar dysfunction and hemo - entered in Microsoft Excel 2016, and statistical analysis dynamic alterations on late-stage microvascular disease was performed using Statistical Package for the Social and vision loss [12]. Science (SPSS) version 21. Means and standard devia- In contrast, a meta-analysis conducted in 2017 tions were calculated to describe continuous variables, included seven studies that did not find apparent differ - whereas numbers and percentages were used for cate- ences in TG, TC, and HDL-C levels between patients gorical variables. Student’s t-test and chi-square test were with and without DR [3]. Further, a retrospective study used to evaluate the differences between categorical vari - that included 191 Japanese participants found no sig- ables. Statistical significance was set at p < 0.05. Quantita- nificant correlation between serum lipid levels with the tive data were presented as mean and standard deviation severity of DR or existence of macular edema despite (mean ± SD), where one-way ANOVA and Kruskal Wallis the significant correlation between the blood glucose, tests were applied according to data normality. HbA1c, and total cholesterol [13]. Multiple logistic regression analysis was performed Although several studies have been conducted on this with DR stage as the dependent variable. topic, the relationship between lipid profile, blood pres - sure, and DR is still unclear, especially in Saudi Arabia. In particular, there are limited studies which have focused Results on the role of lipids as a risk factor for DR. To this end, The study included 165 women (57.1%) and 124 men our study aimed to assess the correlation between both (42.9%). Ninety-six (33.2%) patients had mild NPDR, 103 lipid profile and blood pressure and the development (35.6%) had moderate NPDR, 29 (10%) had severe NPDR, and severity of DR among diabetic patients at the King and 61 (21.1%) had PDR. Abdul-Aziz University Hospital in Jeddah, Saudi Arabia Triglyceride levels were significantly associated with in 2021. the severity of DR; patients with PDR showed signifi - cantly higher TG levels than NPDR patients (P = 0.012). Patients with advanced DR stage showed higher LDL Methodology levels (Table  1). There was no significant relationship This retrospective record review study was conducted in between the progression of DR and cholesterol, DBP, the Department of Ophthalmology at the King Abdul- and HBa1C (P = 0.231, P = 0.256, P = 0.197, respectively) Aziz University Hospital in Jeddah, Saudi Arabia, in June (Table 1). 2021. The study was approved by the Research Ethics A lattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 3 of 5 Table 1 Clinical characteristic of different stages of diabetic retionpathy Mild DR Moderate DR Severe DR PDR P value N = 96 N = 103 N = 29 N = 61 Age 61.25 ± 13.56 62.52 ± 11.34 61.72 ± 9.03 57.92 ± 12.49 0.132* BMI 30.26 ± 6.65 31.89 ± 5.94 31.71 ± 5.30 30.88 ± 6.18 0.285* cholesterol 4.67 ± 1.01 4.85 ± 1.12 5.43 ± 1.41 13.1 ± 60.2 0.231* triglycerides 1.61 ± 0.78 1.88 ± 1.09 1.94 ± 1.11 2.23 ± 1.58 0.012* LDL 2.97 ± 1.02 3.06 ± 0.93 3.61 ± 1.21 3.45 ± 1.08 0.005* HDL 1.28 ± 0.40 1.24 ± 0.51 1.15 ± 0.28 1.29 ± 0.771* 0.85 creatinine 87.68 ± 51.16 83.19 ± 28.76 111.41 ± 149.03 117.83 ± 89.69 0.009* SBP 139.46 ± 16.58 142.66 ± 17.81 151.03 ± 19.66 149.39 ± 18.30 0.001* DBP 73.03 ± 9.97 73.36 ± 10.82 76.98 ± 10.78 75.17 ± 11.98 0.256* HBA1C 8.84 ± 1.62 9.09 ± 1.89 9.25 ± 0.187 9.51 ± 2.38 0.197* *One-way ANOVA Table 2 Multinominal logistic regression analysis the mean GFR, and a high mean creatinine level were risk independent predictors (risk factors) of advanced DR staging factors for advanced DR stage (p ≤ 0.05). Other lipid marker analyses are presented in Table  3. Variable Likelihood ratio Chi-square df p-value Patients with severe NPDR had significantly higher mean Age 461.8 6.54 3 0.088 LDL values than those with other DR stages (p = 0.005). Gender 464.1 8.84 3 0.031 However, a non-significant relationship was found Nationality 458.28 3.03 3 0.388 between the DR stage and HDL (P = 0.534). Macular edema 462.61 7.35 3 0.061 SBPM 456.81 1.55 3 0.669 Discussion DBPM 457.58 2.32 3 0.508 The reported prevalence of DR in Saudi Arabia in 2019 Cholesterol 458.23 2.97 3 0.395 was 33.7% [16]. Diabetes and its complications pose a Cholesterol categories 458.85 3.58 3 0.309 significant personal and public health burden; therefore, Triglycerides 465.02 9.76 3 0.021 identifying and modifying the risk factors for diabetes Triglyceride categories 464.62 9.36 3 0.025 is an important clinical goal. Numerous studies have GFR 473.01 17.75 3 < 0.001 found a correlation between lipid fractions and macro- Creatinine 465.01 7.95 3 0.021 vascular complications of diabetes (e.g., coronary artery HbA1c 455.67 0.41 3 0.938 disease) [17]. However, very few studies have focused on BMI 455.8 0.54 3 0.909 the association between serum lipids and microvascular BMI categories 457.03 1.77 3 0.62 complications such as DR. Our study aimed to assess the association between DR severity, lipid profile, and blood pressure among diabetic patients at the King Abdul-Aziz In our analysis, we found that as SBP increased, the University Hospital in Jeddah. severity of DR also increased (P = 0.001) (Table 1). There Our analysis showed a significant relationship between was no association between DR stage and creatinine TG levels and DR severity, which is comparable to find - level (P = 0.165). Table  2 shows the results of multino- ings reported in India which showed a strong positive mial logistic regression analysis to assess the independent relationship between TG and DR stage [10]. The role of predictors of DR stage. High TG, high TG category, low serum lipids in the development and progression of DR Table 3 Relationship between DR stage and HDL and LDL Variable Mild NPDR Moderate NPDR sever NPDR PDR Test p-value Mean ± SD Mean ± SD Mean ± SD Mean ± SD HDL 1.27 ± 0.39 1.24 ± 0.51 1.15 ± 0.28 1.29 ± 0.84 3* 0.534 LDL 2.97 ± 1.02 3.05 ± 0.93 3.6 ± 1.21 3.44 ± 1.07 4.44** 0.005 N.B.: * Kruskal Wallis test **One Way ANOVA test Alattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 4 of 5 has been evaluated worldwide; hyperlipidemia causes importance of measuring lipid levels and blood pressure endothelial dysfunction due to reduced bioavailability of in patients with diabetes to initiate appropriate treat- nitric oxide and breakdown of the blood retinal barrier, ments and prevent the onset and progression of diabetic which leads to exudation of serum lipids and lipopro- retinopathy and DME. teins, resulting in DR changes [9]. Acknowledgements Other studies have also investigated the relationship We would like to thank Editage (www. edita ge. com) for English language between DR and other lipid parameters. Unlike previ- editing. ous studies which demonstrated an association between Authors’ contributions cholesterol and DR [10], we found no significant associa - We confirm that there are no other persons who satisfied the criteria for tion between serum cholesterol and HDL with DR stage. authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. All authors have read Our observations that there was no association between and approved the final manuscript. DR stage and cholesterol and HDL were consistent with those of previous reports from Turkey and India [13, 18] Funding Not applicable. and those of the WESDR study [19]. This observation is consistent with the mechanism of DR progression which Availability of data and materials is thought to be related to intraretinal lipid transporta- Raw data were generated at King Abdul-Aziz University Hospital.Derived data supporting the findings of this study are available from the corresponding tion, rather than serum lipid levels per se [13]. author D. W. A. on request. In our study, systolic blood pressure was associated with the presence and severity of DR. This result was Declarations consistent with the results of previous studies [5, 10, 20]. Hypertensive patients had a more than two-fold risk of Ethics approval and consent to participate The study was approved by the Research Ethics Committee of King Abdulaziz DR compared to diabetic patients with controlled blood University (KAU) (538–20). There was no participation required. pressure. This may be because the endothelium of the retinal capillaries is injured in DR, and hypertension pro- Consent for publication I, the corresponding author, give my consent for the publication of informa- motes endothelial disturbance [5]. tion, which can include to be published in the International Journal of Retina This study has some limitations worth noting. First, and Vitreous. this was single-center study and therefore further studies Competing interests are warranted to confirm whether the results are translat - Not applicable. able to other healthcare settings. Second, the difference in time of laboratory readings could influence the results. Author details Department of Ophthalmology, College of Medicine, King Abdulaziz Uni- Therefore, further prospective studies are warranted to versity Hospital, Jedddah, Saudi Arabia. Faculty of Medicine, King Abdulaziz validate our results. Also, the small sample size due to University, Jeddah, Saudi Arabia. single-center data consider an important limitation to Received: 25 October 2021 Accepted: 20 February 2022 mention and the number of included participants could be greater. Nevertheless, the results described herein are valuable as this is one of the first studies conducted to assess the correlation between both causation and sever- References ity of DR with lipid profile levels and blood pressure in 1. Lim LS, Wong TY. Lipids and diabetic retinopathy. Expert Opin Biol Ther. Saudi Arabia. 2012;12(1):93–105. 2. Jeng CJ, Hsieh Y T, Yang CM, Yang CH, Lin CL, Wang IJ. Diabetic retin- opathy in patients with dyslipidemia: development and progression. Conclusion Ophthalmol Retina. 2018;2(1):38–45. 3. Zhou Y, Wang C, Shi K, Yin X. Relationship between dyslipidemia and In conclusion, our findings have clear clinical impli - diabetic retinopathy: a systematic review and meta-analysis. Medicine cations. The association of serum lipids, particularly (Baltimore). 2018;97(36): e12283. triglyceride levels, with DR severity and progression sug- 4. Landmesser U, Hornig B, Drexler H. Endothelial dysfunction in hyper- cholesterolemia: mechanisms, pathophysiological importance, and gests that hyperlipidemia may have an impact on DR, therapeutic interventions. Semin Thromb Hemost. 2000;26(5):529–37. despite the lack of association with other lipid param- 5. Wat N, Wong RL, Wong IY. Associations between diabetic retinopathy and eters such as cholesterol and HDL. We also found that systemic risk factors. Hong Kong Med J. 2016;22(6):589–99. 6. Sjølie AK, Stephenson J, Aldington S, Kohner E, Janka H, Stevens L, systolic blood pressure was associated with DR pro- et al. Retinopathy and vision loss in insulin-dependent diabetes in gression. These observations help to clarify some of the Europe, The EURODIAB IDDM Complications Study. Ophthalmology. discrepancies of previous studies and suggest that lipid- 1997;104(2):252–60. 7. Modjtahedi BS, Bose N, Papakostas TD, Morse L, Vavvas DG, Kishan AU. targeting therapies may be more effective in slowing the Lipids and diabetic retinopathy. Semin Ophthalmol. 2016;31(1–2):10–8. progression of DR than in preventing the development of 8. Wang W, Lo ACY. Diabetic retinopathy: pathophysiology and treatments. DR per se. Taken together, these results demonstrate the Int J Mol Sci. 2018. https:// doi. org/ 10. 3390/ ijms1 90618 16. A lattas et al. International Journal of Retina and Vitreous (2022) 8:20 Page 5 of 5 9. Shermin S, Mollah FH, Hoque MM, Arslan MI, Rahman MR. Serum lipids and diabetic retinopathy in newly diagnosed type 2 diabetic subjects. J Enam Med Col. 2012;1(2):63–6. 10. Agroiya P, Philip R, Saran S, Gutch M, Tyagi R, Gupta KK. Association of serum lipids with diabetic retinopathy in type 2 diabetes. Indian J Endo- crinol Metab. 2013;17(Suppl 1):S335–7. 11. Rema M, Srivastava BK, Anitha B, Deepa R, Mohan V. Association of serum lipids with diabetic retinopathy in urban South Indians–the Chennai Urban Rural Epidemiology Study (CURES) Eye Study–2. Diabet Med. 2006;23(9):1029–36. 12. Antonetti DA, Barber AJ, Bronson SK, Freeman WM, Gardner TW, Jefferson LS, et al. Diabetic retinopathy: seeing beyond glucose-induced microvas- cular disease. Diabetes. 2006;55(9):2401–11. 13. Cetin EN, Bulgu Y, Ozdemir S, Topsakal S, Akın F, Aybek H, et al. Associa- tion of serum lipid levels with diabetic retinopathy. Int J Ophthalmol. 2013;6(3):346–9. 14. ETDRS Research Group. Early treatment diabetic retinopathy study design and baseline patient characteristics, ETDRS report number 7. Ophthal- mology. 1991;98(5 Suppl):741–56. 15. Lipsy RJ. The national cholesterol education program adult treatment panel III guidelines. J Manag Care Pharm. 2003;9(1 Suppl):2–5. 16. Yasir ZH, Hassan AD, Rajiv K. Diabetic retinopathy (DR) among 40 years and older Saudi population with diabetes in Riyadh governo- rate, Saudi Arabia—a population based survey. Saudi J Ophthalmol. 2019;33(4):363–8. 17. Moosaie F, Firouzabadi FD, Abouhamzeh K, Esteghamati S, Meysamie A, Rabizadeh S, et al. Lp(a) and Apo-lipoproteins as predictors for micro- and macrovascular complications of diabetes: a case-cohort study. Nutr Metab Cardiovasc Dis. 2020;30(10):1723–31. 18. Idiculla J, Nithyanandam S, Joseph M, Mohan VA, Vasu U, Sadiq M. Serum lipids and diabetic retinopathy: a cross-sectional study. Indian J Endo- crinol Metab. 2012;16(Suppl 2):S492–4. 19. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The wisconsin epidemio- logic study of diabetic retinopathy, VII. Diabetic nonproliferative retinal lesions. Ophthalmology. 1987;94(11):1389–400. 20. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–64. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? Choose BMC and benefit from om: : fast, convenient online submission thorough peer review by experienced researchers in your field rapid publication on acceptance support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year At BMC, research is always in progress. Learn more biomedcentral.com/submissions

Journal

International Journal of Retina and Vitreous – Springer Journals

Published: Mar 9, 2022

Keywords: Diabetic retinopathy; Retinopathy; Lipid profile; DR; Lipid effect

There are no references for this article.