Elevated HDL Confers Lower DR Risk

Research suggests that lipid metabolism likely plays a crucial role in the development of diabetic complications. In the latest study on this topic, higher HDL-C was inversely correlated with DR. Photo: Xie Z, et al. J Diabetes Metab Disord. 2025;24:238. Click image to enlarge. Various studies have suggested that both low and high levels of high-density lipoprotein cholesterol (HDL-C)—the “good” cholesterol—may influence the development and progression of diabetic retinopathy (DR) through metabolic, inflammatory and oxidative stress pathways. Researchers sought to elucidate this relationship by performing a secondary analysis of a cross-sectional study involving more than 2,000 patients with type 2 diabetes. Its findings revealed that those with lower HDL-C exhibited more pronounced retinal damage compared to patients with higher levels. The results were published recently in Journal of Diabetes & Metabolic Disorders.Included in the study were 2,001 diabetic patients (858 men and 1143 women) who visited one of two internal medicine clinics in Taiwan between 2002 and 2004. Biochemical assessments were conducted to measure HDL-C levels alongside other lipid parameters, such as triglycerides and low-density lipoprotein cholesterol. OCT and fundus photos of each patient were analyzed by ophthalmologists to grade DR severity. A diagnosis of DR was made in 35% of the cohort. The results revealed a significant negative correlation between HDL-C levels and the severity of DR; specifically, every 10mg/dL increase in HDL-C was associated with lower odds of developing DR, with an odds ratio of 0.91. These findings support the hypothesis that HDL-C may play a protective role in DR development through mechanisms described by several existing studies, the authors relayed in their paper. “HDL-C has anti-inflammatory and antioxidant properties, which may protect the retina by reducing inflammation and oxidative stress in retinal vessels,” they explained. “Additionally, HDL-C may reduce retinal vascular damage by improving endothelial function and promoting reverse cholesterol transport.”It’s important to note that the data analyzed in this study was collected more than two decades ago; since then, there have been several changes to diagnostic criteria and treatment approaches for both diabetes and DR. Therefore, research using data from modern-day patients may be necessary to validate this study’s findings.In conclusion, given that lipid metabolism appears to play a crucial role in diabetic complications, the researchers argue, “It is advisable for clinical practice to enhance the monitoring of HDL-C levels and implement interventions when necessary to reduce the risk of DR.” They suggested that future research should focus on exploring “the mechanistic role of HDL-C, particularly its effects across different populations, and how optimizing lipid profiles may improve ocular health in diabetic patients.”Click here for the journal source. Xie Z, Luo X, Ling D, et al. The linear association between high-density lipoprotein cholesterol and diabetic retinopathy: a cross-sectional study in diabetic patients. J Diabetes Metab Disord. 2025;24:238. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.