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Diabetic Retinopathy and Serum Lipoprotein Subclasses in the DCCT/EDIC Cohort

¹From the Section of Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; the ²Division of Endocrinology, Diabetes, and Medical Genetics, and the ⁴Department of Biometry, Medical University of South Carolina, Charleston, South Carolina; the ⁵Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama; and the ⁶Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.

PURPOSE. To determine associations between retinopathy status and detailed serum lipoprotein subclass profiles in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) cohort.

METHODS. Persons with type 1 diabetes (440 women, 548 men) from the DCCT/EDIC cohort were studied. Retinopathy was characterized by Early Treatment Diabetic Retinopathy Study (ETDRS) scores, hard exudate scores, and ETDRS scores minus the hard exudate component. Lipoproteins were characterized by conventional lipid profile, nuclear magnetic resonance lipoprotein subclass profile (NMR-LSP), apoA1, apoB, lipoprotein(a), and susceptibility of LDL to oxidation. Data were analyzed with and without the following covariates: age, gender, duration of diabetes, HbA_1c, albumin excretion rate (AER), creatinine clearance, hypertension, body mass index, waist-hip ratio, DCCT treatment group, smoking status.

RESULTS. The severity of retinopathy was positively associated with triglycerides (combined cohort) and negatively associated with HDL cholesterol (men, combined cohort). NMR-LSP identified retinopathy as being positively associated with small and medium VLDL and negatively with VLDL size. In men only, retinopathy was positively associated with small LDL, LDL particle concentration, apoB concentration, and small HDL and was negatively associated with large LDL, LDL size, large HDL, and HDL size. No associations were found with apoA1, Lp(a), or susceptibility of LDL to oxidation. All three measures of retinopathy revealed the same associations.

CONCLUSIONS. NMR-LSP reveals new associations between serum lipoproteins and severity of retinopathy in type 1 diabetes. The data are consistent with a role for dyslipoproteinemia involving lipoprotein subclasses in the pathogenesis of diabetic retinopathy.

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