Association of Serum Low-Density Lipoprotein Cholesterol and Total Cholesterol with the Severity of Diabetic Retinopathy: A Cross-Sectional Study

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Background: Diabetic retinopathy is a major microvascular complication of diabetes mellitus and an important cause of visual impairment. Dyslipidemia may contribute to retinal vascular damage and progression of diabetic retinopathy. This study assessed the association of serum low-density lipoprotein cholesterol and total cholesterol with the severity of diabetic retinopathy. Methods: A cross-sectional study was conducted among 72 patients with diabetic retinopathy. Participants aged ≥18 years with diabetes and diabetic retinopathy were included, while those with gestational diabetes, long-term steroid use, media opacity preventing fundus visualization, or lipid-lowering therapy were excluded. Clinical and laboratory data were collected using a structured questionnaire. Diabetic retinopathy was assessed by visual acuity testing, fundoscopy, and/or color fundus photography. Serum lipid parameters were measured using standard laboratory methods. Data were analyzed using SPSS version 24.0. One-way ANOVA with Bonferroni post-hoc analysis was performed, with p<0.05 considered statistically significant. Results: The mean age of participants was 53.92±9.42 years, with male predominance. Moderate to severe NPDR was the most common retinal finding. Total cholesterol and LDL cholesterol showed significant differences across diabetic retinopathy severity groups (both p<0.001), whereas triglycerides and HDL cholesterol were not significantly associated with severity. Post-hoc analysis demonstrated significant differences in LDL and total cholesterol between several retinopathy categories, particularly across increasing NPDR severity. Conclusion: Serum LDL cholesterol and total cholesterol were significantly associated with diabetic retinopathy severity. Assessment and appropriate management of lipid abnormalities may have an important role in comprehensive diabetic retinopathy care.

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