Oxidized Low-Density Lipoprotein and the Incidence of Proliferative Diabetic Retinopathy and Clinically Significant Macular Edema Determined From Fundus Photographs

Abstract

IMPORTANCE Studies have shown oxidized low-density lipoprotein to be associated with the incidence of proliferative retinopathy and other complications of type 1 diabetes mellitus. Because low-risk interventions are available to modify oxidized low-density lipoprotein, it is important to examine the relationships between this factor and the incidence of proliferative retinopathy and of macular edema, 2 important causes of visual impairment in people with type 1 diabetes.OBJECTIVE To determine the association of oxidized low-density lipoprotein with the worsening of diabetic retinopathy and the incidence of proliferative retinopathy and of macular edema.

Extravascular modified lipoproteins: a role in the propagation of diabetic retinopathy in a mouse model of type 1 diabetes

“…Most of these studies focus on standard measures of circulating lipids and lipoproteins, and in general, they show associations between ‘dyslipidaemia’, for example elevated plasma LDL-cholesterol or apolipoprotein B (apoB), and the severity of diabetic retinopathy. Some studies have gone further, addressing qualitative (and not just quantitative) changes in plasma lipoproteins, including the extent of LDL modification by oxidation [ 15 ]. We have previously reported associations between diabetic retinopathy severity and average lipoprotein particle diameters and the distribution of ‘subclasses’ of HDL, LDL, and VLDL in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort [ 10 ].…”

“…Also in that cohort, we found that circulating immune complexes containing oxidised LDL (ox-LDL) predicted severe diabetic retinopathy many years later [ 13 ]. Overall, however, associations between plasma lipoproteins and diabetic retinopathy, although statistically significant in population studies, are too weak to define individual risk or prognosis, as recently underlined in two detailed reports [ 14 , 15 ].…”

Effects of Modified Low-Density Lipoproteins and Fenofibrate on an Outer Blood-Retina Barrier Model: Implications for Diabetic Retinopathy

“…Historically, plasma lipoproteins have been linked with DR in epidemiological studies, [22][23][24] but the associations are too weak to define individual risk. 25,26 It is known that the retina has an intricate physiological lipid system, which shares similarities with other organs, but also has unique features. 27 In addition, we have observed pathological accumulation of oxidatively modified lipoproteins in the retinas of diabetic patients (presumably after extravasation due to leaking BRBs with ensuing modification accelerated by the diabetic milieu).…”

No effect of yeast-like fungi on lipid metabolism and vascular endothelial growth factor level in children and adolescents with type 1 diabetes mellitus

“…Higher HDL cholesterol levels were seen in T1DM children with disease duration <5 years and HbA1c = 7.0 + 1.2% versus T1DM patients with disease duration >5 years and HbA1c = 8.1 + 0.9%. Currently available data on lipid metabolism in T1DM patients are not unanimous [6, 28–30]. Recently, unexpected results have been presented by Klein et al, who studied 730 patients for 24 years, each patient having been tested four times, and did not show any relationship between increased serum levels of oxidized low-density lipoprotein and frequency of macular oedema or diabetic retinopathy severity in T1DM patients [28].…”

“…Currently available data on lipid metabolism in T1DM patients are not unanimous [6, 28–30]. Recently, unexpected results have been presented by Klein et al, who studied 730 patients for 24 years, each patient having been tested four times, and did not show any relationship between increased serum levels of oxidized low-density lipoprotein and frequency of macular oedema or diabetic retinopathy severity in T1DM patients [28]. In other studies the authors pointed at lipid profile abnormalities in patients with disease duration longer than 5 years, with poor metabolic control and cardiovascular complications [6, 29, 30].…”