ASSOCIATION OF ELEVATED SERUM-LIPID LEVELS WITH RETINAL HARD EXUDATE IN DIABETIC-RETINOPATHY - EARLY TREATMENT DIABETIC-RETINOPATHY STUDY (ETDRS) REPORT 22

Objective: To evaluate the relationship between serum lipid levels, re tinal hard exudate, and visual acuity in patients with diabetic retino pathy. Design: Observational data from the Early Treatment Diabetic Re tinopathy Study. Participants: Of the 3711 patients enrolled in the Ea rly Treatment Diabetic Retinopathy Study, the first 2709 enrolled had serum lipid levels measured. Main Outcome Measures: Baseline fasting s erum lipid levels, best-corrected visual acuity, and assessment of ret inal thickening and hard exudate from stereoscopic macular photographs . Results: Patients with elevated total serum cholesterol levels or se rum low-density lipoprotein cholesterol levels at baseline were twice as likely to have retinal hard exudates as patients with normal levels . These patients were also at higher risk of developing hard exudate d uring the course of the study. The risk of losing visual acuity was as sociated with the extent of hard exudate even after adjusting for the extent of macular edema. Conclusions: These data demonstrate that elev ated serum lipid levels are associated with an increased risk of retin al hard exudate in persons with diabetic retinopathy. Although retinal hard exudate usually accompanies diabetic macular edema, increasing a mounts of exudate appear to be independently associated with an increa sed risk of visual impairment. Lowering elevated serum lipid levels ha s been shown to decrease the risk of cardiovascular morbidity. The obs ervational data from the Early Treatment Diabetic Retinopathy Study su ggest that lipid lowering may also decrease the risk of hard exudate f ormation and associated vision loss in patients with diabetic retinopa thy. Preservation of vision may be an additional motivating factor for lowering serum lipid levels in persons with diabetic retinopathy and elevated serum lipid levels.