High Levels of “Good” Cholesterol Associated with Dry AMD

High-density lipoprotein cholesterol is known as “good” cholesterol and is linked to lower risk of heart disease. However, this lipid has been linked to increased risk for age-related macular degeneration. Photo:  Wendy Harrison, OD, PhD, and Joe Wheat, OD, PhD. Click image to enlarge. To address discrepancies in published literature, researchers from Israel conducted a study to determine how varying levels of high-density lipoprotein cholesterol (HDL-C) affect the risk of age-related macular degeneration (AMD).This study collected electronic healthcare data from 70 United States facilities available using the TriNetX network. Data from 2005 to 2025 was collected.A total of 1.29 million person-years were identified in this study. Only patients with two or more HDL-C measurements taken at least three months apart were accepted. High-level HDL-C (n=1,013,645) was defined as ≥60mg/dL and low level (n=494,029) was defined as ≤39mg/dL. Groups were then matched at a 1:1 ratio based on health history (demographics, medications, comorbidities). Researchers found 186,532 subjects who matched in both the high- and low-level groups.“In this retrospective cohort study, high HDL-C levels were associated with a significantly increased risk of incident nonexudative AMD across early, intermediate and advanced atrophic stages,” mentioned the authors in their paper published in Investigative Ophthalmology & Visual Science, “whereas associations with exudative AMD were weaker and less consistent, compared with consistently low HDL-C levels. These findings support subtype-specific effects of HDL-C on AMD pathogenesis.”Hazard ratios (HR) were calculated to determine the risk of AMD. For high HDL-C, the risk of nonexudative AMD had an HR of 1.53, while exudative AMD had an HR of 1.37. As the researchers pointed out, an increased risk for nonexudative AMD was found across every stage outlined in their study. Here are the results for each stage:Early atrophic stage: HR=1.55Intermediate atrophic stage: HR=1.82 Advanced atrophic stage: HR=1.85After calculating these results, researchers analyzed their matched cohorts and compared them to the overall population. They found that “for both nonexudative and exudative AMD, results were directionally consistent across all specifications, with stable effect estimates observed when matching on demographics alone and after sequential inclusion of comorbidities, laboratory values and lipid-lowering medications.”Researchers conclude their paper by suggesting that future mechanistic studies should focus on furthering the understanding of HDL-C functionality in the retina. Also, prospective studies should be conducted to determine whether interventions that increased HDL-C levels correlate with AMD incidence.Click here for the source. Nitzan I, Jaskoll S, Kramer A, et al. High-density lipoprotein cholesterol levels and risk of age-related macular degeneration. Invest Ophthalmol Vis Sci 2026;67:4:69.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.