Serum lipid and inflammatory markers in age-related macular degeneration: an exploratory cross-sectional analysis from the Beichen Eye Study

This population-based study examined cross-sectional associations of serum lipid and inflammatory biomarkers with age-related macular degeneration (AMD). We analyzed data from 4,748 participants aged 50 years and older in the Beichen Eye Study. We assessed eight composite biomarkers: TG-to-HDL-C, HDL-C-to-LDL-C, neutrophil-to-HDL-C ratio (NHR), lymphocyte-to-HDL-C ratio (LHR), monocyte-to-HDL-C ratio (MHR), platelet-to-HDL-C ratio (PHR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR). The four standard lipid parameters (TC, TG, HDL-C, LDL-C) were examined as a prespecified secondary analysis. Multivariable logistic regression models were adjusted for age, sex, body mass index (BMI), fasting glucose, diabetes, hypertension, smoking, alcohol consumption, coronary heart disease, and statin use. Statistical significance was defined using Bonferroni-corrected thresholds of P < 0.00625 (0.05/8) for the eight primary composite biomarkers and P < 0.0125 (0.05/4) for the four standard lipid parameters. Among 4,748 participants, 1,245 had AMD (prevalence 26.22%; 95% CI 24.98%–27.49%). In the primary tertile-based analysis of the eight composite biomarkers, the highest TG-to-HDL-C tertile showed a nominal inverse association with AMD (OR = 0.80, 95% CI 0.69–0.95; P for trend = 0.010), and the highest NHR tertile showed a nominal inverse association (OR = 0.83, 95% CI 0.69–0.98; P for trend = 0.032); no composite biomarker survived the primary Bonferroni threshold ( P < 0.00625). In the prespecified secondary analysis of the standard lipid parameters, the highest TG tertile showed an inverse association with AMD (OR = 0.79, 95% CI 0.67–0.94; P for trend = 0.006), meeting the secondary threshold ( P < 0.0125), whereas HDL-C showed no association in tertile analysis (P for trend = 0.165). In continuous-variable sensitivity analyses, HDL-C was positively associated with AMD ( P = 0.010 and 0.017), whereas the TG association attenuated ( P = 0.020 and 0.052). In this exploratory cross-sectional analysis, TG-to-HDL-C ratio, TG, and HDL-C showed nominal or model-dependent associations with prevalent AMD that did not consistently survive correction for multiple comparisons; the positive HDL-C association was observed only in continuous-variable sensitivity analyses. These findings identify candidate biomarkers for validation in prospective cohorts but do not support their use in clinical risk assessment.