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Fabian Kananen, Timo Strandberg, Sirpa Loukovaara, Petteri Karesvuo, Ilkka J Immonen; Early middle-age cholesterol levels and the risk of age-related maculopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1158. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
There is conflicting evidence on the association between serum lipid levels and AMD. The studies to date have examined elderly patients when signs of AMD often are present. We examined, whether cholesterol in early middle age is associated with the risk of AMD later in life.
We examined subjects from a cohort of young (31-54 years) male executives studied in the sixties for cardiovascular risk.194 subjects from the original cohort were graded using AREDS classification and drusen size from photographs taken in 2005-2012.Total cholesterol (TC), Triglyceride (TG, 70 patients), blood pressure and Body Mass Index (BMI) were taken at baseline. Lipids, BMI, smoking and statins were recorded in 2011. The subjects were genotyped for the AMD risk SNPs of CFH, ARMS 2, C3 and APOE. Associations with AMD level (3 cut-off levels) and drusen size (2 cut-off levels) were tested with Student's t-test and Fischer’s exact test when appropriate. Multivariate analysis was performed with binary logistic regression. Bonferroni correction was applied for all multiple comparisons.
Table 1 shows key characteristics of the subjects. TC measured at baseline 1964-1973 was significantly higher in subjects with intermediate or late AMD (6.67 vs. 6.20 mmol/L p=0.024) and largest drusen size ≥125 µm (6.68 vs. 6.21 mmol/L p=0.030) compared with the rest of the subjects. BMI at baseline associated to any AMD (p=0.049) and late AMD (p=0.012).In 2011 TC (5.01 mmol/L without AMD vs. 4.67 mmol/L with any AMD p=0.019), LDL (2.92 vs. 2.62 p=0.015) and triglyceride (1,20 vs. 1.09 p=0.045), levels respectively, were lower in patients with any AMD compared to those without. There was no difference in HDL levels.Of the AMD risk SNPs, the ARMS2 rs10490924 was associated with any (p=0.002), intermediate or late (p<0.001) and late (p=0.002) AMD as well as largest drusen size ≥125 µm (p<0.001).In logistic regression (Table 2), baseline TC was associated with intermediate or late AMD (OR 1.59, p=0.004) and largest drusen size ≥125 µm (OR 1.57, p=0.006) when corrected for age, BMI, AMD risk SNPs and smoking, whereas 2011 lipid values had no association.
High TC may have a role in the the early development of AMD, especially in patients later developing large drusen. Early saturation of the Bruch’-RPE basal membrane from serum lipids may contribute to impaired transport and debris accumulation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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