Does having a high LDL-C to HDL-C ratio increase heart risks if I have diabetic retinopathy?
If you have diabetic retinopathy, you are already at higher risk for heart problems. Research shows that the ratio of LDL cholesterol (the 'bad' kind) to HDL cholesterol (the 'good' kind) can help predict that risk. A ratio of 2.0 or higher is linked to a nearly doubled risk of cardiovascular events, even in people already on statin therapy.
What the research says
A large analysis of the EMPATHY study, which included over 5,000 people with type 2 diabetes and diabetic retinopathy who were taking statins, found that those with an LDL-C to HDL-C ratio of 2.0 or higher had a significantly greater risk of cardiovascular events over about 3 years 411. The risk was nearly double (hazard ratio 1.89) compared to those with a lower ratio, even after adjusting for other factors like age and sex 411. This finding was consistent whether the ratio was measured at the start of the study or after 12 months 411. Other research also links dyslipidemia (unhealthy cholesterol levels) to diabetic retinopathy and related kidney problems, suggesting that cholesterol imbalances play a role in both eye and heart health 10. While diabetic retinopathy itself is a marker of blood vessel damage, the LDL/HDL ratio adds extra information about your heart risk 411.
What to ask your doctor
- What is my current LDL-C to HDL-C ratio, and is it in a healthy range?
- Given my diabetic retinopathy, should I have my cholesterol levels checked more often?
- If my ratio is high, what treatment options (beyond statins) might help lower my heart risk?
- Are there other heart risk tests, like a coronary calcium scan, that might be useful for me?
This question is drawn from common patient questions about Diabetes & Endocrinology and answered using cited medical research. We do not provide individualized advice.