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HDL Cholesterol Linked to Higher Risk of Glaucoma in Adults Over 55 Years
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Key Takeaways
- Higher HDL-C levels may increase glaucoma risk, contradicting its typical health benefits in cardiovascular contexts.
- Elevated LDL-C, TC, and TG levels were associated with a reduced risk of glaucoma in the study cohort.
The results act as a contradiction to conventional wisdom of high-density lipoprotein (HDL) cholesterol being healthy and lowering the risk of heart disease, but more research is warranted.
According to data from investigators of a large observational, prospective study, high-density lipoprotein (HDL) cholesterol (HDL-C) may be linked to a heightened risk of glaucoma, a condition that could lead to blindness, in adults over the age of 55. The results, published in the British Journal of Ophthalmology, constitute a paradox with HDL-C’s typical classification as having health benefits and lowering the risk of heart disease.1-3
HDL cholesterol helps prevent plaque from clogging arties, improving cardiovascular outcomes. | Image Credit: © Rasi - stock.adobe.com
Healthy levels of HDL-C help pick up excess cholesterol in the bloodstream, transporting the cholesterol back to the liver, where it can be broken down and flushed out of the body. This process prevents plaque buildup in arteries, which improves the risk of stroke, heart disease, and other adverse cardiovascular outcomes. However, the findings from this study challenge conventional wisdom of which factors may improve or damage eye health and the risk of glaucoma, which damages the optic nerve of patients over time.1,3,4
The study investigators sought to further examine the associations of common serum lipid measures, including HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG), and the risk of glaucoma. In total, the cohort included 400,229 participants from the UK Biobank. To measure the associations between serum lipids and glaucoma, the investigators employed Cox regression and restricted cubic spline models, in addition to polygenic risk scores. Polygenic risk scores allow for a personalized measure of genetic susceptibility to certain diseases by utilizing genetic risk information from throughout the patient’s genome.1
Follow-up occurred over a mean of 14.44 years; across this time, 6868 (1.72%) participants developed glaucoma. According to the multivariate Cox regression analysis, higher levels of HDL-C were associated with a heightened risk of glaucoma (HR: 1.05; 95% CI, 1.02-1.08; P = .001). Contrastingly, elevated levels of LDL-C (HR: 0.96; 95% CI, 0.94-0.99, P = .005), TC (HR: 0.97; 95% CI 0.94-1.00, P = .037), and TG (HR: 0.96; 95% CI 0.94-0.99, P = .008) were all linked to a reduced risk of developing glaucoma.2
Further analyses examined the associations between the polygenic risk score of serum lipids and glaucoma. These results indicated a per 1-standard deviation (SD) increment of HDL-C genetic risk was linked to a 5% greater hazard of glaucoma (HR: 1.05; 95% CI, 1.00-1.11; P = .031). Despite these results, the investigators noted in their report that the polygenic risk scores of LDL-C, TC, and TG were not significantly associated with glaucoma.2
In their discussion, the study authors noted that no major conclusions can be drawn regarding cause and effect of HDL-C levels and the risk of glaucoma due to the study being observational. Additionally, multiple limitations to their findings were acknowledged, including not taking patient blood samples following a period of fasting and only taking samples at a single time point. Critically, as participants in the UK Biobank are predominantly of European ancestry, the findings may not be generalizable to other ethnic groups.1
Still, the study authors agree that the findings “challenge existing paradigms about ‘good’ and ‘bad’ cholesterol in relation to eye health” and “could prompt a re-evaluation of lipid management strategies in patients at risk for glaucoma.”1
REFERENCES
1. BMJ Group. ‘Good’ cholesterol may be linked to heightened glaucoma risk among over 55s. EurekAlert! News Release. Released February 4, 2025. Accessed February 28, 2025. https://www.eurekalert.org/news-releases/1072325
2. Ma Y, Wu Y, Hu L, et al. Associations between serum lipids and glaucoma: A cohort study of 400,229 UK Biobank participants. BMJ Ophthalmology. 2025. doi:10.1136/bjo-2024-326062
3. Mayo Clinic Staff. HDL cholesterol: How to boost your ‘good’ cholesterol. Mayo Clinic. Last Updated November 7, 2024. Accessed February 28, 2025. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/hdl-cholesterol/art-20046388
4. Cleveland Clinic. HDL cholesterol. Last Updated November 6, 2023. Accessed February 28, 2025. https://my.clevelandclinic.org/health/articles/24395-hdl-cholesterol
