This article is more than 5 years old. Information may no longer be current.
Large data set correlates cholesterol levels with AMD
Click Here to Manage Email Alerts
HDL cholesterol and triglycerides have, respectively, a positive and negative association with increased risk for age-related macular degeneration, particularly in the early stages, according to a study.
Researchers analyzed the correlation between circulating lipid levels and AMD, as well as the association with specific genetic variants, in a large data set from the European EYE-RISK project, involving 14 studies in seven countries.
This study, like several other studies, was triggered by the notion that drusen are deposits of lipid-rich proteins, resembling the formation of artherosclerotic plaques in cardiovascular disease. Systemic lipid levels, as well as specific genes involved in lipid metabolism, may therefore have significant correlations with drusen and early AMD.
A total of 4,730 individuals with early AMD, 2,441 with late AMD and 23,782 nonaffected subjects were identified within the EYE-RISK database. Lipid levels and genotype data were recorded.
A positive association was found between higher HDL cholesterol and an increased risk for any AMD, with slightly higher estimates for early AMD. Conversely, triglycerides were negatively associated with early AMD and any AMD. The same correlations were found with drusen size and area: Higher HDL levels were associated with greater drusen size and area, whereas higher triglycerides were associated with smaller drusen size and area. Genetic analysis did not lead to clear-cut answers.
“The more pronounced risk for early AMD and increasing [odds ratios] of HDL cholesterol for the larger drusen suggest that lipids play an important role at the early phase of disease. Hypothetically, intervention at this phase would be most promising in preventing blindness,” the authors wrote. “Whether systemic lipids directly influence lipid metabolism in the retina or whether these lipids mirror pathologic features in the retina is a question that remains to be answered.” – by Michela Cimberle
Disclosures: Colijn reports no relevant financial disclosure. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to TopPaolo Lanzetta, MD
This study shows that, in a large population, HDL cholesterol, particularly extra-large subfraction, is positively associated with increased risk for early AMD and drusen, while triglycerides are negatively associated. The authors cannot ascertain whether systemic lipids directly intervene on the lipid metabolism of the retina or rather the studied lipids mirror degenerative conditions of the retina.
Notably, the authors underline that the levels of the studied lipids were within physiologic range in both cases and controls and that absolute differences were small in millimoles per liter. Also, the authors postulate that systemic HDL might be a biomarker of AMD rather than be directly involved in the pathogenesis of the disease. Unfortunately, no evidence of effect on any lipid subfraction could be found in the subgroup of patients using lipid-lowering drugs, probably due to the lower power of this specific population. Therefore, at this stage there are not enough and clear data to influence routine clinical practice.
As the authors correctly conclude, large randomized controlled trials with long-term follow-up are needed to clarify the relationship between lipid-lowering drugs and AMD.
Click Here to Manage Email Alerts