Link Between 'Good' Cholesterol and Increased Glaucoma Risk in Older Adults

Wed 5th Feb, 2025

Recent research indicates a potential connection between high levels of 'good' cholesterol (HDL) and an increased risk of glaucoma in individuals aged 55 and older. This finding, emerging from a substantial observational study published in the British Journal of Ophthalmology, challenges longstanding beliefs regarding cholesterol's impact on eye health.

Glaucoma, a serious eye condition that can lead to irreversible vision loss, is expected to affect approximately 112 million individuals globally by 2040. Established risk factors for this condition include age, ethnicity, intraocular pressure, and family history. The study's researchers aimed to explore the relationship between cholesterol levels and glaucoma, especially considering previous inconsistent findings regarding lipids and eye health.

The investigation drew on data from 400,229 participants aged 40 to 69 years from the UK Biobank Study. Each participant completed questionnaires, underwent interviews, and had blood tests to measure lipid levels. Over an average follow-up period of 14 years, 6,868 participants (nearly 2%) developed glaucoma.

Comparative analysis revealed that individuals who developed glaucoma tended to be older, had higher HDL cholesterol levels, and lower LDL cholesterol levels, along with a higher waist-to-hip ratio indicating central obesity. Additionally, these individuals were more likely to be ex-smokers and to be prescribed statins, while also showing a higher prevalence of diabetes, hypertension, and cardiovascular diseases.

Notably, the study found a direct association between elevated HDL levels and an increased risk of glaucoma. Specifically, participants with the highest HDL cholesterol levels were found to be 10% more likely to develop glaucoma compared to those with the lowest levels. Furthermore, each standard deviation increase in HDL cholesterol was linked to a corresponding 5% rise in glaucoma risk. In contrast, higher levels of LDL cholesterol and triglycerides were associated with a lower likelihood of developing the condition, suggesting a complex relationship between different types of cholesterol and eye health.

These patterns were particularly pronounced in participants over 55, with no significant associations observed in younger individuals aged 40 to 55. The analysis also considered the influence of sex and the type of glaucoma diagnosed.

The researchers created a polygenic risk score to evaluate genetic susceptibility to glaucoma, indicating that each additional genetic risk factor increased the odds of developing glaucoma by 5%. However, no significant associations were found for LDL cholesterol, total cholesterol, or triglycerides when analyzed individually.

Despite the compelling nature of these findings, the study's observational design limits the ability to establish definitive cause-and-effect relationships. The researchers acknowledged several limitations, including the non-fasting nature of blood sample collection and potential applicability issues to non-European ethnic groups, as the UK Biobank participants are predominantly of European descent.

The implications of this research could lead to a reevaluation of current management strategies for patients with high lipid levels who are at risk for glaucoma. The study's authors suggest that the long-held view of HDL cholesterol as universally beneficial may require reconsideration, as their findings indicate that high levels of HDL cholesterol do not consistently correlate with improved eye health outcomes.

In conclusion, while HDL cholesterol has been regarded as the 'good cholesterol' for decades, the evidence presented in this study highlights the need for further investigation into its effects on glaucoma risk, calling for more nuanced approaches in lipid management among at-risk populations.


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