High Cholesterol in Middle Age Can Lead To Macular Disease Later in Life

Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries.
High systemic total cholesterol in early middle age may play a role in initial development of AMD.

In early middle age, serum cholesterol levels may be associated with the development of age-related macular degeneration (AMD), especially in patients who have large drusen, according to a study published in Acta Ophthalmologica.

The study looked at 209 participants of the Helsinki Businessmen Study (HBS) over the course of several decades. The researchers noted the total cholesterol (TC), triglyceride, and body mass index (BMI) measured from 1964 to 1973 — the HBS baseline. Then, in 2011, lipid subfractions, BMI, smoking status, and statin use were recorded and compared. In addition, investigators obtained fundus photographs that they graded for AMD between 2005 and 2012. They were also genotyped for the main AMD risk single nucleotide polymorphisms (SNPs).

Researchers found that the TC measured at baseline was significantly higher in those who developed intermediate or late AMD (6.67 mmol/l vs 6.20 mmol/l, P =.024) or with drusen size of 125 μm or greater (6.68 mmol/l vs 6.21 mmol/l, P =.030) when compared with remaining study participants. At the 2011 follow-up, values such as TC, LDL, and TG were lower in participants with AMD. HDL levels showed no differences. 

They also found that baseline TC was associated with intermediate or late AMD (OR 1.59, P =.004) and drusen size 125 μm or greater (OR 1.57, P =.006) when corrected for age, BMI, AMD risk SNPs, and smoking.

“In this study, we found an association between early middle age serum TC and later intermediate or late AMD, and largest drusen size of ≥125 μm. A subset analysis showed a correlation between lower TG levels in early middle age and the presence of drusen ≥125 μm at older age,” the study says. “We are not aware of previous published studies on the role of early lipid values on AMD development.”

The study’s limitations include its long time span between the baseline and study follow-up, which might’ve introduced bias. In addition, because the sample size of the current study cohort is only 9.7%, selection bias might have occurred. Also, researchers didn’t have information about the diet/dietary changes of patients in the follow-up and only statins were used, so other lipid-lowering medications were not analyzed.


Kananen F, Strandberg T, Loukovaara S, Immonen I. Early middle age cholesterol levels and the association with age-related macular degeneration. Acta Ophthalmol. Published online February 3, 2021. doi:10.1111/aos.14774