Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy
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REVIEW
Open Access
Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy Yuyu Chou1, Jin Ma1, Xin Su2* and Yong Zhong1*
Abstract Hyperlipidemia is correlated with a series of health problems. Notably, aside from its established role in promoting cardiovascular morbidity and mortality, hyperlipidemia has also been considered for modulating the risk and the severity of multiple metabolic disorders. According to the results of epidemiologic investigations, several certain circulating lipoprotein species are correlated with the prevalence of diabetic retinopathy, suggesting that the physiological and pathological role of these lipoproteins is analogous to that observed in cardiovascular diseases. Furthermore, the lipid-lowering treatments, particularly using statin and fibrate, have been demonstrated to ameliorate diabetic retinopathy. Thereby, current focus is shifting towards implementing the protective strategies of diabetic retinopathy and elucidating the potential underlying mechanisms. However, it is worth noting that the relationship between major serum cholesterol species and the development of diabetic retinopathy, published by other studies, was inconsistent and overall modest, revealing the relationship is still not clarified. In this review, the current understanding of hyperlipidemia in pathogenesis of diabetic retinopathy was summarized and the novel insights into the potential mechanisms whereby hyperlipidemia modulates diabetic retinopathy were put forward. Keywords: Hyperlipidemia, Diabetic retinopathy, Lipid profiles, Lipid-lowering treatment, Pathophysiology, Statin, Fibrate, Inflammation
Introduction Hyperlipidemia, characterized by reduced circulating high-density lipoprotein cholesterol (HDL-C), elevated circulating low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C), has been verified to be closely correlated with a series of cardio-metabolic disorders, such as obesity, hypertension, and coronary heart disease [1]. For instance, the process whereby excessive LDL-C intrudes into the subendothelium is intimately involved in the cascade to atherosclerotic lesions; meanwhile, reduced circulating * Correspondence: [email protected]; [email protected] 2 Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, Xiamen 363001, Fujian, China 1 Department, of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
LDL-C levels retard the process of atherosclerosis [2]. On the other hand, the HDL particle displays a vital anti-atherosclerotic effect since it accepts cholesterol from peripheral tissues for delivery to the liver through a classical method that is called reverse cholesterol transport (RCT). Additionally, the well-established antioxidative function of HDL, which prevents the oxidation progression of LDL particle into ox-LDL particle, also inhibits the initial atheroma formation with
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