People over 55 with High Levels of “Good” Cholesterol Have Heightened Glaucoma Risk

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People over 55 with High Levels of “Good” Cholesterol Have Heightened Glaucoma Risk


People over 55 with High Levels of “Good” Cholesterol Have Heightened Glaucoma Risk
Credit: anusorn nakdee/Getty Images

A large observational study using data from the UK Biobank has found that high levels of high-density lipoprotein (HDL), the so-called “good” cholesterol could increase the risk of glaucoma in individuals aged 55 and older. The study, conducted by researchers in China and published today in the British Journal of Ophthalmology, also showed that higher levels of low-density lipoprotein (LDL), the “bad” cholesterol, appeared to reduce the risk of developing the condition.

“The findings suggest that a rethink may be needed of how patients with high blood fats and who are at risk of glaucoma, are treated,” the researchers wrote in their publication.

Glaucoma is a condition that damages the optic nerve and can lead to irreversible blindness. It is estimated it will affect 112 million people globally by 2040. Common risk factors include age, ethnicity, family history, and increased pressure within the eye. The study’s researchers aimed to explore the potential connection between cholesterol levels and glaucoma, since other research has shown that higher lipid levels have been linked to other eye conditions like macular degeneration and diabetic retinopathy.

For this research, the investigators analyzed data from 400,229 participants in the UK Biobank, aged 40 to 69, who had undergone blood tests to measure cholesterol levels. Over an average follow-up period of 14 years, 6,868 participants developed glaucoma. The researchers found that, compared to those without glaucoma, participants with the condition were older, more likely to be non-White, had higher HDL cholesterol levels, and tended to have lower LDL cholesterol.

The data showed that people with the highest HDL levels were 10% more likely to develop glaucoma compared with those who had the lowest levels, with every standard deviation increase conferring a 5% increased risk. Conversely, higher levels of LDL cholesterol and triglycerides were associated with a reduced risk of glaucoma, with each increase in LDL and triglycerides lowering the risk by 8% and 14%, respectively.

The researchers said these associations were particularly pronounced in participants over the age of 55 and that the relationship between cholesterol and glaucoma varied by sex and the type of glaucoma. For example, high HDL levels were associated with an increased risk of both primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), while triglycerides only increased the risk for POAG in males.

In addition to their analysis of the risk of glaucoma inferred by different levels of cholesterol and triglycerides in the blood, the researchers also created a polygenic risk score (PRS) for glaucoma. The PRS This showed that each additional genetic risk was associated with 5% higher odds of developing glaucoma. But there were no significant individual associations between LDL cholesterol, total cholesterol, or triglycerides and glaucoma.

The researchers noted the study had some limitations, such as the fact that blood samples were not taken after fasting, and participants in the UK Biobank are predominantly of European ancestry, which potentially limits the applicability of the results to other populations.

These limitations noted, the researchers nonetheless believe that “These findings challenge existing paradigms about ‘good’ and ‘bad’ cholesterol in relation to eye health. This could prompt a re-evaluation of lipid management strategies in patients at risk for glaucoma.”

“HDL cholesterol has been regarded as the ‘good cholesterol’ for seven decades,” they continued. “However, this study demonstrates that high levels of [it] are not consistently associated with a favorable prognostic outcome. Further studies are needed to investigate the mechanisms behind these associations.”



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