High remnant cholesterol level is relevant to diabetic retinopathy in type 2 diabetes mellitus

Abstract

Background Diabetic retinopathy (DR) is the primary oculopathy causing blindness in diabetic patients. Currently, there is increasing interest in the role of lipids in the development of diabetic retinopathy, but it remains controversial. Remnant cholesterol (RC) is an inexpensive and easily measurable lipid parameter; however, the relationship between RC and DR in type 2 diabetes mellitus (T2DM) has not been elucidated. This research investigates the relevance between RC levels and DR severity while building a risk prediction model about DR. Methods In this single-centre retrospective cross-sectional study. Each hospitalised T2DM patient had no oral lipid-lowering drugs in the past three months, and coronary angiography showed epicardial coronary artery stenosis of less than 50% and completed seven-field stereo photographs, fluorescein fundus angiography, and optical coherence tomography detection. The RC value is calculated according to the internationally recognised formula. Binary logistic regression was used to correct confounding factors, and the receiver operating characteristic (ROC) analysis was used to identify risk factors and assess the nomogram’s diagnostic efficiency. Results A total of 456 T2DM patients were included in the study. The RC levels in the DR team was higher [0.74 (0.60–1.12) mmo/l vs 0.54 (0.31–0.83) mmol/l P < 0.001] in the non-DR team. After adjusting for confounding elements, RC levels are still associated with DR risk (OR = 5.623 95%CI: 2.996–10.556 P < 0.001). The ratio of DR in every stage (except mild non-proliferative diabetic retinopathy) and DME in the high RC level team were further increased compared to the low-level team (all P < 0.001). After ROC analysis, the overall risk of DR was predicted by a nomogram constructed for RC, diabetes duration, and the neutrophil-lymphocyte ratio as 0.758 (95%CI 0.714–0.802 P < 0.001). Conclusions High RC levels may be a potential risk factor for diabetic retinopathy, and the nomogram does better predict DR. Despite these essential findings, the limitation of this study is that it is single-centred and small sample size analysis.

Predictive Value of the Advanced Lipoprotein Profile and Glycated Proteins on Diabetic Retinopathy

“…Elevated cholesterol remnants have recently been reported as a potential risk factor for DR in T2D subjects [ 58 ]; however, we did not observe elevations in the serum concentrations of this lipoprotein class in our T2D subjects with DR. The reason for the inconsistent results between the former study and our data is currently unknown, but it could be partly explained by the different approaches used to estimate the remnant cholesterol concentrations in each study.…”

“…The reason for the inconsistent results between the former study and our data is currently unknown, but it could be partly explained by the different approaches used to estimate the remnant cholesterol concentrations in each study. In this respect, our NMR analysis provided a more accurate estimation of serum cholesterol remnant concentrations than that used in the previous studies [ 56 , 58 ], which simply consisted of subtracting the LDL-C and HDL-C moieties from Total-C. Like in the case of T1D, IDL lipids did not contribute to improving predicting DR in our cohort of subjects with T2D.…”

The non-linear link between remnant cholesterol and diabetic retinopathy: a cross-sectional study in patients with type 2 diabetic mellitus

“…In a cross-sectional study including 456 Chinese with type 2 diabetes, Shan et al found that RC levels were positively associated with DR risk [ 2 ]. At the same time, the prevalence of DR in their study was 47.59%, whereas it was 35.13% in our study [ 2 ].…”

“…Lipids are risk factors for macrovascular disease. According to some recent studies, conventional serum lipid levels such as total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) were not significantly associated with DR [ 2 , 3 ]. Remnant cholesterol (RC) is the cholesterol content of triglyceride-rich lipoproteins, which are very-low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) in the fasting state and the non-fasting state chylomicron remnants [ 4 ].…”

“…Researchers have begun investigating the link between RC and diabetic retinopathy in recent years. A Chinese cross-sectional study including 456 patients showed that a high RC level is associated with DR in type 2 diabetes mellitus (T2DM) [ 2 ]. Another study found that RC could predict diabetic nephropathy and retinopathy progression in type 1 diabetes [ 8 ].…”