Hypercholestolaemia predicts disease progression in primary open-angle glaucoma

Abstract

Purpose : To investigate the association of serum cholesterol with baseline and longitudinal glaucomatous disease progression.

Methods :
A Prospective longitudinal cohort study of 2056 eyes from 1026 pre-perimetric and perimetric glaucoma cases drawn from the Progression Risk of Glaucoma: Relevant SNPs with Significant Association (PROGRESSA) study.

Lipid profiles were measured on serum samples obtained at study enrolment. Mixed effects multivariable linear regression compared lipid parameters to baseline and longitudinal SD-OCT peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thickness data, and with longitudinal Humphrey Visual Field data.

Results : After accounting or age, sex, IOP and lipid lowering therapy, a higher serum total cholesterol was associated with a thinner average mGCIPL thickness (Beta: -0.98 [-1.59, -0.37] P<0.001), thinner worst mGCIPL hemisphere (Beta -1.11um/SD [-1.86, -0.36] P=0.004), and thinner worst pRNFL quadrant thickness (Beta: -1.92um/SD [-3.41, -0.44] P=0.011) at study enrolment. A higher serum LDL-cholesterol concentration was associated with a thinner average mGCIPL thickness (Beta: -0.81um/SD [-1.4, -0.22] P=0.007), a thinner worst mGCIPL hemisphere (Beta: -1.02um/SD [-1.8, -0.29] P=0.006), and a thinner worst pRNFL quadrant (Beta: -1.81um/SD [-3.25, -0.36] P=0.014).

Review of longitudinal progression data (mean follow up: 6.6±1.8years) showed that a higher total cholesterol was associated with a greater risk of visual field progression (HR:1.13/SD, [1.02, 1.26] P=0.023). A higher LDL cholesterol was associated with a faster rate of average mGCIPL thinning (Beta:-0.06um/year/SD [-0.11, -0.001] P=0.045), a faster rate of mGCIPL thinning in the faster progressing hemisphere (Beta: -0.073um/year/SD [-0.14, -0.001] P=0.046), a faster rate of average pRNFL progression (Beta: -0.06um/year/SD, [-0.12, -0.01] P=0.018), and a faster rate of pRNFL thinning in the faster progressing quadrant (Beta: -0.11um/year/SD, [-0.21, -0.002] P=0.045). Further evaluation identified that a higher genetic risk score for LDL-cholesterol was associated with a thinner average mGCIPL thickness(Beta:-0.95um/SD [-1.75, -0.15] P=0.020), and a thinner worst affected pRNFL quadrant (Beta:-1.87um/SD [-0.02, -3.72] P=0.049).

Conclusions : Hyperlipidaemia is an important risk factor for disease progression in glaucoma.

This is a 2021 ARVO Annual Meeting abstract.