These authors contributed equally to this study.
Associations and interactions between lipid profiles, retinopathy and nephropathy in patients with type 1 diabetes: the FinnDiane Study
Article first published online: 1 AUG 2013
© 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 274, Issue 5, pages 469–479, November 2013
How to Cite
Abstract. on behalf of the FinnDiane Study Group (University of Helsinki, Helsinki; Helsinki University Central Hospital, Helsinki; Helsinki University Central Hospital, Helsinki; Institute for Health and Welfare, Helsinki; Finland; University of California, Los Angeles, USA; Helsinki University Central Hospital, Helsinki, Finland; and Baker IDI Heart and Diabetes Institute, Melbourne, Australia). Associations and interactions between lipid profiles, retinopathy and nephropathy in patients with type 1 diabetes: the FinnDiane Study. J Intern Med 2013; 274: 469–479., , , , , , , , , , , ,
- Issue published online: 16 OCT 2013
- Article first published online: 1 AUG 2013
- Accepted manuscript online: 12 JUL 2013 02:26AM EST
- Folkhälsan Research Foundation. Grant Numbers: LSHB-CT-2006-037681, CEED Project 223211
- European Union's Seventh Framework Program. Grant Numbers: LSHB-CT-2006-037681, CEED Project 223211
- Wilhelm and Else Stockmann Foundation
- Finnish Medical Society
- Liv och Hälsa Foundation
- Sigrid Juselius Foundation
- Waldemar von Frenckell Foundation
- Finnish Cultural Foundation
- Finnish Eye Foundation
- European Commission. Grant Numbers: LSHB-CT-2006-037681, CEED Project 223211, FP7/2007-2013
- diabetic nephropathy;
- type 1 diabetes
The aim of this study was to investigate the associations between lipid profiles and retinopathy in the large nationwide FinnDiane Study and to examine interactions and correlations between retinopathy, nephropathy and lipid variables.
Design and subjects
A total of 1465 patients with type 1 diabetes, available lipid profiles, ophthalmic records and fundus photographs were included in the study. The Early Treatment of Diabetic Retinopathy Study scale was used to assess the severity of retinopathy. In an independent cohort of 1100 patients, laser treatment was used to define severe diabetic retinopathy.
HDL cholesterol was associated with proliferative retinopathy (PDR), and triglycerides were associated with mild nonproliferative retinopathy (NPDR) independently of nephropathy and other conventional risk factors (P < 0.01). Significant interactions were seen between albumin excretion rate (AER), retinopathy status and lipid parameters (including triglycerides, non-HDL cholesterol and apolipoprotein B; P < 0.001). Highly different correlations between AER and lipid variables were observed in patients without retinopathy or with mild NPDR compared with patients with moderate to severe NPDR or PDR. Similar interactions and correlations were observed in an independent cohort stratified by laser treatment. In patients without retinopathy or with mild NPDR, AER was low despite HDL cholesterol in the lowest or triglycerides, total cholesterol or LDL cholesterol in the highest quartiles.
Nephropathy had a strong effect on the associations between lipid variables and retinopathy, whilst dyslipidaemia was associated with nephropathy only in the presence of retinopathy. This finding suggests the existence of shared pathogenic mechanisms between retinopathy and nephropathy which could be targeted to prevent complications in patients with metabolic risk factors.