title: Association of serum lipid levels with retinal hard exudate area in African Americans with type 2 diabetes.
abstract: OBJECTIVE
  Previous studies have yielded conflicting results regarding whether serum lipid levels are associated with retinal hard exudates in diabetic retinopathy. The majority of studies have assessed hard exudates only as a dichotomous trait (presence vs. absence) and included limited numbers of African Americans (AA). The purpose of this study was to determine if there are any associations between serum lipid levels and hard exudates in AA with type 2 diabetes (T2D).
  
  
  METHODS
  890 AA participants with T2D were enrolled from 5 sites. Macular fundus photographs were graded by masked ophthalmologist investigators. Hard exudate areas were measured using a semi-automated algorithm and ImageJ software. Multivariate regression models were used to determine the association between serum lipid levels and (1) presence of hard exudate and (2) area of hard exudate.
  
  
  RESULTS
  Presence of hard exudates was associated with higher total cholesterol [(odds ratio (OR) = 1.08, 95 % confidence interval (CI) 1.03-1.13, P = 0.001)] and higher low-density lipoprotein (LDL) cholesterol (OR = 1.08, 95 % CI 1.03-1.14, P = 0.005) in models controlling for other risk factors. Hard exudate area was also associated with both higher total and LDL cholesterol levels (P = 0.04 and 0.01, respectively) in multivariate models controlling for other risk factors.
  
  
  CONCLUSIONS
  Higher total and LDL cholesterol were associated with the presence of hard exudates and a greater hard exudate area in AA with T2D. This information can be used to counsel diabetic patients regarding the importance of lipid control to decrease the risk of macular hard exudates.
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Papavasileiou
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Davoudi
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.|Department of Ophthalmology, Farabi Eye Hospital, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ramak
authors.initials: R
authors.lastname: Roohipoor
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.|Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Heeyoon
authors.initials: H
authors.lastname: Cho
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
authors.forename: Shreyas
authors.initials: S
authors.lastname: Kudrimoti
authors.affiliation: Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Hancock
authors.affiliation: Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Wilson
authors.affiliation: Visual Services Department, Harvard Vanguard Medical Associates, Boston, MA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Andreoli
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
authors.forename: Deeba
authors.initials: D
authors.lastname: Husain
authors.affiliation: Ophthalmology, St Dominic's Hospital, Jackson, MS, USA.
authors.forename: Maurice
authors.initials: M
authors.lastname: James
authors.affiliation: Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA.|Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Penman
authors.affiliation: Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Ching J
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA. Lucia_sobrin@meei.harvard.edu.
authors.forename: Lucia
authors.initials: L
authors.lastname: Sobrin
mesh_terms: D001741:Black or African American; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000208:ethnology; D003930:Diabetic Retinopathy / Q000097:blood* / Q000150:complications / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D008055:Lipids / Q000097:blood*; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000097:blood* / Q000208:ethnology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D008055:Lipids
keywords: African Americans; Hard exudate area; Serum lipid levels; Type 2 diabetes