A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes
A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes
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DOI：
10.2337/diabetes.53.11.2883
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发表时间：
2004-11-01
期刊：
影响因子：
7.7
通讯作者：
Schaumberg, DA
中科院分区：
文献类型：
--
作者：
Miljanovic, B;Glynn, RJ;Schaumberg, DA
我们在1型糖尿病人群中评估了血脂水平与临床显著性黄斑水肿（CSME）、硬性渗出物和其他糖尿病视网膜病变（DR）终点之间的关系。我们研究了1,441名糖尿病控制和并发症试验（DCCT）参与者每年测量的血脂数据。我们使用比例风险回归模型来检查脂质水平（总胆固醇、LDL和HDL胆固醇、总胆固醇与HDL胆固醇比率和甘油三酯）的累积平均值与CSME、硬性渗出物、DR进展和增殖性DR（PDR）发展的关系。在控制一级预防与二级干预亚组、随机治疗分配、HbA（1c）和其他风险因素的模型中，总胆固醇与HDL胆固醇比值和LDL均可预测CSME的发生（极端五分位数的率比[RR]为3.84，总胆固醇与HDL胆固醇比值的趋势P = 0.03，RR为1.95，LDL的趋势P = 0.03）和硬性渗出物（RR 2.44，总-HDL胆固醇比的趋势P = 0.0004，LDL的RR 2.77，趋势P = 0.002）。调整HbA（1c）后，血脂与DR进展和PDR发展的关系较弱且不显著。高血脂与CSME和视网膜硬性渗出物的风险增加相关。在1型糖尿病受试者中进行降脂治疗，建议预防心血管疾病，也可能降低CSME的风险，CSME是视力丧失的重要原因。
We evaluated the relationships between serum lipid levels and clinically significant macular edema (CSME), hard exudates, and other diabetic retinopathy (DR) end points in a population with type 1 diabetes. We studied data from serum lipids that were measured annually among the 1,441 Diabetes Control and Complications Trial (DCCT) participants. We used proportional hazards regression models to examine the relationship of the cumulative average of lipid levels (total, LDL, and HDL cholesterol, total-to-HDL cholesterol ratio, and triglycerides) with development of CSME, hard exudate, DR progression, and development of proliferative DR (PDR). In models controlling for primary prevention versus secondary intervention subgroup, randomized treatment assignment, HbA(1c), and other risk factors, both total-to-HDL cholesterol ratio and LDL predicted development of CSME (rate ratio [RR] for extreme quintiles 3.84, P for trend = 0.03 for total-to-HDL cholesterol ratio, and RR 1.95, P for trend = 0.03 for LDL) and hard exudate (RR 2.44, P for trend = 0.0004 for total-to-HDL cholesterol ratio, and RR 2.77, P for trend = 0.002 for LDL). Relationships of lipids with progression of DR and development of PDR were weaker and not significant after adjustment for HbA(1c). Higher serum lipids are associated with increased risk of CSME and retinal hard exudate. Lipid-lowering treatment among type 1 diabetic subjects, recommended to prevent cardiovascular disease, may also decrease risk of CSME, an important cause of vision loss.