The Association Between Lipid Profile and Subfoveal Choroidal Thickness in Chinese Patients with Proliferative Diabetic Retinopathy Secondary to Type 2 Diabetes

Figures & data

Table 1 Baseline Characteristics of Participants with Proliferative Diabetic Retinopathy

	Mean±SD/n (%)	Total Cholesterol (mmol/L)		P-value
		<6.22	≥6.22
N	131	119	12
Age (year)	55.76 ± 9.88	55.55 ± 9.81	57.83 ± 10.79	0.449
Male sex	83 (63.36%)	77 (64.71%)	6 (50.00%)	0.314
SBP (mmHg)	139.60 ± 20.31	138.88 ± 20.26	145.92 ± 20.53	0.257
DBP (mmHg)	85.08 ± 10.82	85.34 ± 11.05	82.75 ± 8.56	0.434
BMI (kg/m^2)	24.24 ± 3.00	24.25 ± 3.03	24.19 ± 2.81	0.953
Duration of diabetes (year)	12.57 ± 6.99	12.47 ± 6.93	13.50 ± 7.75	0.629
Visual acuity (logMAR)	0.75 ± 0.54	0.72 ± 0.54	1.03 ± 0.45	0.056
IOP (mmHg)	16.27 ± 4.08	16.29 ± 4.14	16.04 ± 3.57	0.847
Ocular axial length (mm)	23.22 ± 1.02	23.25 ± 1.02	22.87 ± 0.97	0.347
CMT (μm)	289.83 ± 128.46	288.38 ± 128.51	304.19 ± 132.73	0.686
SFCT (μm)	276.10 ± 92.92	278.67 ± 86.68	250.57 ± 143.76	0.320
Education level				0.665
Junior high school or below	75 (57.25%)	69 (57.98%)	6 (50.00%)
Senior high school	26 (19.85%)	24 (20.17%)	2 (16.67%)
College or above	30 (22.90%)	26 (21.85%)	4 (33.33%)
Systemic diseases
Hypertension	67 (51.15%)	57 (47.90%)	10 (83.33%)	0.019
Chronic kidney disease history	35 (26.72%)	31 (26.05%)	4 (33.33%)	0.587
Stroke history	8 (6.11%)	8 (6.72%)	0 (0.00%)	0.354
Heart disease history	6 (4.58%)	6 (5.04%)	0 (0.00%)	0.426
Systemic medication history
Insulin treatment	80 (61.07%)	71 (59.66%)	9 (75.00%)	0.299
Oral glucose-lowering drugs	98 (74.81%)	90 (75.63%)	8 (66.67%)	0.495
Calcium antagonists	41 (31.30%)	34 (28.57%)	7 (58.33%)	0.034
Ophthalmological treatment history
Anti-VEGF therapy	40 (30.53%)	37 (31.09%)	3 (25.00%)	0.662
PRP				0.333
None	57 (43.51%)	54 (45.38%)	3 (25.00%)
Partial	27 (20.61%)	23 (19.33%)	4 (33.33%)
Whole	47 (35.88%)	42 (35.29%)	5 (41.67%)
Laboratory data
Fasting blood glucose (mmol/L)	7.22 ± 2.69	7.15 ± 2.76	7.93 ± 1.78	0.341
HbA1c (%)	7.66 ± 1.71	7.75 ± 1.77	6.86 ± 0.66	0.140
Total cholesterol (mmol/L)	4.60 ± 1.19	4.34 ± 0.89	7.14 ± 0.79	<0.001
HDL-C (mmol/L)	1.31 ± 0.41	1.28 ± 0.34	1.60 ± 0.78	0.009
LDL-C (mmol/L)	2.68 ± 1.02	2.47 ± 0.76	4.77 ± 0.98	<0.001
Triglyceride (mmol/L)	1.50 ± 0.75	1.44 ± 0.70	2.08 ± 1.02	0.004
Serum creatinine (µmol/L)	152.02 ± 189.46	147.48 ± 182.98	197.00 ± 250.25	0.390
eGFR (mL/min×1.73m^2)	65.79 ± 30.04	67.38 ± 30.16	50.07 ± 24.71	0.057

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; HbA1c, hemoglobin A1c; logMAR, logarithmic minimum resolution angle; IOP, intraocular pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; CMT, central macular thickness; SFCT, subfoveal choroidal thickness; VEGF, vascular endothelial growth factor; PRP, panretinal photocoagulation.

Table 2 Univariate Linear Regression Analysis of SFCT in Participants with Proliferative Diabetic Retinopathy

	β, 95% CI	P-value
Age, per 1 year increase	−2.68 (−4.24, −1.13)	0.0009
Male vs female	38.91 (6.44, 71.38)	0.0203
SBP, per 1 mmHg increase	0.57 (−0.26, 1.41)	0.1815
DBP, per 1 mmHg increase	1.85 (0.30, 3.40)	0.0213
BMI, per 1 kg/m^2 increase	2.72 (−2.90, 8.34)	0.3451
Duration of diabetes, per 1 year increase	−0.51 (−2.84, 1.82)	0.6663
Visual acuity, per 1 logMAR increase	1.40 (−28.46, 31.27)	0.9268
IOP, per 1 mmHg increase	1.04 (−2.91, 4.99)	0.6073
Ocular axial length, per 1 mm increase	−0.47 (−1.89, 0.94)	0.5134
CMT, per 1 μm increase	0.02 (−0.10, 0.14)	0.7524
Education level
Junior high school or below	Reference
Senior high school	−9.96 (−51.66, 31.74)	0.6403
College or above	6.78 (−32.80, 46.36)	0.7376
Systemic diseases
Hypertension vs absent	−3.80 (−35.75, 28.15)	0.8161
Chronic kidney disease history vs absent	38.58 (3.10, 74.07)	0.0350
Stroke history vs absent	−1.30 (−68.01, 65.41)	0.9695
Heart disease vs absent	5.49 (−70.92, 81.89)	0.8883
Systemic medication history
Insulin vs absent	22.16 (−10.38, 54.70)	0.1842
Oral glucose-lowering drugs vs absent	−43.36 (−79.39, −7.33)	0.0198
Calcium antagonists vs absent	37.18 (3.33, 71.03)	0.0332
Ophthalmological treatment history
Anti-VEGF therapy vs absent	32.04 (−2.20, 66.28)	0.0690
PRP
None	Reference
Partial	5.83 (−36.43, 48.09)	0.7874
Whole	34.28 (−1.36, 69.92)	0.0617
Laboratory data
Fasting blood glucose, per 1 mmol/L increase	−2.10 (−8.04, 3.85)	0.4902
HbA1c, per 1% increase	0.50 (−3.64, 4.64)	0.8144
Total cholesterol, per 1 mmol/L increase	−16.08 (−29.25, −2.91)	0.0181
HDL-C, per 1 mmol/L increase	−42.66 (−81.44, −3.89)	0.0329
LDL-C, per 1 mmol/L increase	−15.27 (−30.72, 0.17)	0.0548
Triglyceride, per 1 mmol/L increase	−3.01 (−24.36, 18.34)	0.7828
Serum creatinine, per 1 µmol/L increase	0.08 (−0.00, 0.16)	0.0648
eGFR, per 1 mL/min×1.73m^2 increase	−0.12 (−0.66, 0.41)	0.6470

Abbreviations: CI, confidence interval; SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; HbA1c, hemoglobin A1c; logMAR, logarithmic minimum resolution angle; IOP, intraocular pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; CMT, central macular thickness; SFCT, subfoveal choroidal thickness; VEGF, vascular endothelial growth factor; PRP, panretinal photocoagulation.

Table 3 Relationship Between Lipid Profile and SFCT in Participants with Proliferative Diabetic Retinopathy

Exposure	Model I		Model II		Model III
	β, 95% CI	P-value	β, 95% CI	P-value	β, 95% CI	P-value
Total cholesterol (mmol/L)	−13.48 (−26.87, −0.09)	0.0506	−14.71 (−27.42, −2.00)	0.0251	−16.51 (−29.57, −3.46)	0.0148
HDL-C (mmol/L)	−33.94 (−73.31, 5.43)	0.0936	−42.38 (−80.27, −5.40)	0.0267	−42.65 (−82.60, −2.70)	0.0390
LDL-C (mmol/L)	−12.90 (−28.60, 2.80)	0.1098	−14.98 (−29.91, −0.06)	0.0513	−17.89 (−33.24, −2.54)	0.0245
Total cholesterol (mmol/L) group
<6.22	Reference		Reference		Reference
≥6.22	−20.91 (−75.85, 34.03)	0.4571	−27.03 (−79.37, 25.31)	0.3130	−42.07 (−97.70, 13.55)	0.1414
Triglyceride (mmol/L)	−1.71 (−22.95, 19.52)	0.8747	3.60 (−17.10, 24.29)	0.7340	5.23 (−18.57, 29.02)	0.6678

Notes: Model I adjusted for: age and sex. Model II adjusted for age, sex, and ocular axial length. Model III adjusted for age, gender, ocular axial length, PRP, duration of diabetes, serum creatinine, DBP, HbA1c, anti-VEGF therapy, oral glucose-lowering drugs, and oral calcium antagonists.

Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SFCT, subfoveal choroidal thickness; VEGF, vascular endothelial growth factor; PRP, panretinal photocoagulation.

Figure 1 Smooth curve fitting between lipid profile and SFCT in patients with proliferative diabetic retinopathy. (A–D) present the tendency between total cholesterol, HDL-C, LDL-C, triglyceride, and SFCT, respectively.

Table 4 The Results of Stratified Analysis in Participants with Proliferative Diabetic Retinopathy

Y= SFCT, μm	N	Total Cholesterol (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)		Triglyceride (mmol/L)
		β, 95% CI	P-value	β, 95% CI	P-value	β, 95% CI	P-value	β, 95% CI	P-value
Gender
Female	48	−19.80 (−38.61, −0.99)	0.0492	−98.49 (−163.85, −33.14)	0.0066	−23.98 (−46.19, −1.77)	0.0441	24.47 (−7.69, 56.63)	0.1479
Male	83	−12.18 (−30.17, 5.81)	0.1896	−31.20 (−82.95, 20.54)	0.2420	−11.63 (−32.92, 9.65)	0.2884	−1.72 (−35.40, 31.97)	0.9208
Age (year)
<53	45	−30.22 (−59.36, −1.08)	0.0538	−51.53 (−128.77, 25.71)	0.2039	−29.00 (−64.82, 6.82)	0.1262	−0.71 (−36.39, 34.97)	0.9692
≥53	86	−14.29 (−31.00, 2.41)	0.0985	−42.64 (−92.30, 7.03)	0.0975	−15.59 (−34.82, 3.63)	0.1169	11.14 (−21.88, 44.16)	0.5110
PRP
None	57	−13.47 (−32.77, 5.84)	0.1793	−95.84 (−161.33, −30.35)	0.0066	−12.65 (−35.52, 10.21)	0.2848	34.69 (−9.48, 78.86)	0.1318
Partial	27	−9.92 (−44.14, 24.31)	0.5879	−12.18 (−102.96, 78.60)	0.8002	−14.04 (−58.44, 30.36)	0.5550	−14.62 (−72.10, 42.86)	0.6334
Whole	47	1.88 (−28.89, 32.64)	0.9058	−45.95 (−133.77, 41.86)	0.3141	−3.94 (−34.69, 26.81)	0.8036	36.86 (−6.00, 79.73)	0.1034
Oral glucose-lowering drugs
No	33	−14.93 (−60.04, 30.18)	0.5263	−72.23 (−211.16, 66.69)	0.3243	−20.03 (−84.82, 44.76)	0.5536	14.98 (−53.27, 83.23)	0.6732
Yes	98	−17.33 (−30.51, −4.14)	0.0121	−35.07 (−75.34, 5.20)	0.0923	−17.48 (−32.68, −2.28)	0.0273	−3.19 (−30.69, 24.31)	0.8207
Calcium antagonist
No	90	−19.31 (−34.06, −4.56)	0.0127	−33.21 (−73.40, 6.97)	0.1102	−19.47 (−36.97, −1.97)	0.0330	−0.68 (−28.68, 27.32)	0.9621
Yes	41	−19.30 (−58.12, 19.52)	0.3403	−57.26 (−199.69, 85.16)	0.4391	−20.59 (−60.76, 19.58)	0.3260	11.40 (−47.28, 70.08)	0.7070
Anti-VEGF therapy
No	91	−16.38 (−31.59, −1.17)	0.0386	−53.00 (−96.93, −9.07)	0.0210	−16.84 (−34.77, 1.09)	0.0703	10.08 (−16.99, 37.15)	0.4681
Yes	40	−24.29 (−50.84, 2.26)	0.0881	−33.63 (−137.75, 70.50)	0.5339	−25.21 (−57.15, 6.74)	0.1377	−30.42 (−78.58, 17.75)	0.2301
eGFR (mL/min×1.73m^2)
<60	55	−19.87 (−42.49, 2.76)	0.0952	14.42 (−95.03, 123.88)	0.7979	−23.18 (−48.02, 1.66)	0.0771	−25.61 (−68.01, 16.80)	0.2456
≥60	76	−18.26 (−35.43, −1.08)	0.0421	−51.84 (−95.40, −8.29)	0.0236	−17.90 (−38.59, 2.79)	0.0960	24.39 (−9.94, 58.72)	0.1697
Hypertension history
No	64	−15.95 (−34.62, 2.71)	0.1016	−54.18 (−114.53, 6.18)	0.0860	−13.82 (−33.67, 6.03)	0.1799	18.59 (−17.86, 55.04)	0.3234
Yes	67	−20.32 (−45.64, 5.01)	0.1230	−33.20 (−96.86, 30.45)	0.3122	−22.99 (−52.89, 6.92)	0.1391	−4.63 (−43.84, 34.57)	0.8179
Chronic kidney disease history
No	96	−14.57 (−28.57, −0.56)	0.0453	−39.69 (−76.36, −3.02)	0.0374	−12.86 (−29.24, 3.51)	0.1280	7.64 (−17.68, 32.97)	0.5560
Yes	35	8.25 (−43.39, 59.88)	0.7597	18.59 (−191.86, 229.04)	0.8654	7.30 (−58.29, 72.89)	0.8309	13.03 (−50.67, 76.73)	0.6955

Notes: Each stratification was adjusted for all factors (age, gender, ocular axial length, PRP, duration of diabetes, serum creatinine, DBP, HbA1c, anti-VEGF therapy, oral glucose-lowering drugs, and oral calcium antagonists), except the stratification factor itself.

Abbreviations: CI, confidence interval; SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; SFCT, subfoveal choroidal thickness; VEGF, vascular endothelial growth factor; PRP, panretinal photocoagulation.