Lipid profile and future risk of exudative age-related macular degeneration development: a nationwide cohort study from South Korea

Abstract

This nationwide population-based cohort study evaluated the association between lipid profiles and the future risk of exudative age-related macular degeneration (AMD) using authorized clinical data provided by the Korean National Health Insurance Service. A total of 6,129,616 subjects over 50 years of age who participated in the Korean National Health Screening Program in 2013 or 2014 were included. Data on risk factors, including age, sex, comorbidities, behavioral factors, and baseline lipid profiles, including total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels were collected. Patients were followed-up patients until December 2018, and incident cases of exudative AMD were identified using registered diagnostic codes. During an average follow-up period of 4.91 years, 18,803 patients were newly diagnosed with exudative AMD. Compared to the lowest HDL cholesterol quartile group, the highest HDL cholesterol quartile group had a greater risk of future exudative AMD development with a hazard ratio (95% confidence interval) of 1.13 (1.08-1.18) in the fully adjusted model. The highest TG quartile group had a lower risk of exudative AMD than the lowest TG quartile group, with a hazard ratio (95% confidence interval) of 0.84 (0.81-0.88). High HDL cholesterol and low TG levels were prospectively associated with exudative AMD incidence.

Figure 1

Flow chart of the cohort study design.

Figure 2

Restricted cubic spline curves presenting the adjusted hazard ratio for exudative age-related macular degeneration incidence according to total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride level. Curves represent HRs (solid lines) and their 95% CIs (dashed lines) based on restricted cubic splines for baseline total cholesterol (A), HDL cholesterol (B), LDL cholesterol (C), and triglyceride (D) levels with knots at the 5th, 35th, 65th, and 95th percentiles and the reference point at the 5th percentile of their distributions. The risk of exudative age-related macular degeneration continuously increased as HDL cholesterol levels increased (B) and triglyceride levels decreased (D) in the Cox proportional hazards model fully adjusted for demographic factors, systemic comorbidities, and behavioral factors (model 3).