Past Plasma Lipids, Apolipoprotein E4 Polymorphism and the Risk for Age-Related Maculopathy: The Alienor Study

Abstract

Purpose: : Lipid metabolism may be implicated in the aetiology of age-related maculopathy (ARM). In the present study, we investigate the associations of ARM with plasma lipids and apoliprotein E (ApoE) polymorphism.

Methods: : The Alienor Study is a population-based epidemiological study on nutrition and age-related eye diseases. 963 subjects were recruited from September 2006 to May 2008 in Bordeaux (France). ApoE polymorphism and plasma lipids were determined in 889 subjects (92.3 %), from blood collected in 1999-2001. 816 of 889 (91.8 %) had gradable photographs and were classified in 5 exclusive stages (worse eye): neovascular ARM (stage 4, n= 23); geographic atrophy (stage 3, n=23); large soft indistinct drusen and/or reticular drusen and/or large distinct drusen with pigment abnormalities (stage 2, n=87); large soft distinct drusen alone or pigment abnormalities alone (stage 1, n=150); stage 0 (n=533). Associations were estimated using polytomous logistic regression, after adjustment for age and gender.

Results: : Subjects with high HDL-cholesterol were at higher risk of any ARM (OR= 1.26, 95 % confidence interval (CI): 1.08 - 1.47 for 1-SD increase, p= 0.004). The associations were similar with the different stages of ARM (OR ranging from 1.12 to 1.57). Total- and LDL-cholesterol and triglycerides were not significantly associated with any ARM. ApoE4 (at least one allele) tended to be associated with decreased risk of any ARM (OR=0.71, 95 % CI : 0.47 - 1.06 , p=0.09) and showed similar associations with the different stages of ARM (OR ranging from 0.22 to 0.99). There was a significant interaction with age (p=0.06) : apoE4 was not significantly associated with any ARM in subjects younger than 80 years (OR= 1.03, 95 % CI: 0.61 - 1.73 , p=0.90), but was significantly associated with decreased risk in subjects older than 80 years (OR=0.39, 95 % CI: 0.21 - 0.74, p=0.004). There was no statistical interaction of HDL with apoE4 and the association of any ARM with HDL persisted after further adjustment for apoE4, Complement Factor H Y402H polymorphism and smoking (OR= 1.28, 95 % CI : 1.09 - 1.50 for 1 SD increase, p=0.003).

Conclusions: : In this population-based study, HDL-cholesterol measured 7 years before the eye examination was strongly associated with the risk of ARM, while apoE4 polymorphism was associated with decreased risk, but only in subjects aged more than 80 years.

Keywords: age-related macular degeneration • lipids • genetics