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Association of serum lipid levels with retinal hard exudate area in African Americans with type 2 diabetes

  • Retinal Disorders
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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).


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.


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.


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.

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The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities.

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Correspondence to Lucia Sobrin.

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This study was supported by the following grants: American Diabetes Association Clinical Translational Research Award 1-11-CT-51, Alexandria, VA. Research to Prevent Blindness Career Development Award, New York City, NY; Harvard Catalyst | The Harvard Clinical and Translations Science Center Faculty Fellowship, Boston, MA; Massachusetts Lions Eye Research Fund, Abington, MA; Eleanor and Miles Shore Fellowship, Boston, MA; Sara Elizabeth O’Brien Trust, Boston, MA; Research to Prevent Blindness William & Mary Greve Special Scholar Award; Alcon Research Institute Young Investigator Award. The sponsors had no role in the design or conduct of this research.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. None of the authors have any proprietary interests or conflicts of interest related to this submission.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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This submission has not been published anywhere previously and is not simultaneously being considered for any other publication.

Evangelia Papavasileiou and Samaneh Davoudi contributed equally to this work.

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Papavasileiou, E., Davoudi, S., Roohipoor, R. et al. Association of serum lipid levels with retinal hard exudate area in African Americans with type 2 diabetes. Graefes Arch Clin Exp Ophthalmol 255, 509–517 (2017).

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