Subtype-Specific Associations Between Hyperlipidemia and Age-Related Cataract: A Clinic-Based Cross-Sectional Study

Age-related cataract (ARC) is the leading cause of global blindness in the elderly. An unbalanced metabolic state is known to contribute to lens epithelial cell dysfunction and ARC pathogenesis. However, the relationship between hyperlipidemia and ARC remains controversial.

In this cross-sectional study based in the Eye and Ears, Nose, and Throat Hospital, Fudan University, a total of 384 ARC subjects were included, and stratified by cataract morphology (cortical, nuclear, and posterior subcapsular cataract [PSC]). Detailed ocular and systemic evaluations were performed. Ordinal univariate and multivariate logistic regression analyses were used to identify associations between serum biochemical indices and ARC severity.

After adjusting for potential confounders, multivariate analysis revealed that hyperlipidemia was independently associated with PSC severity. Specifically, elevated apolipoprotein B (APO-B; odds ratio [OR], 1.767; 95% confidence interval [CI], 1.297-2.408) and triglycerides (TG; OR, 1.311; 95% CI, 1.014-1.697) were significant risk factors, while high-density lipoprotein cholesterol (HDL-C; OR, 0.738; 95% CI, 0.572-0.952) demonstrated an inverse association. In contrast, cortical cataract severity was independently associated with female sex (OR, 1.829; 95% CI, 1.147-2.916), elevated APO-B (OR, 1.231; 95% CI, 1.012-1.498) and lactate dehydrogenase (LDH; OR, 1.264; 95% CI, 1.040-1.536). Nuclear cataract was primarily associated with older age (OR, 1.608; 95% CI, 1.301-1.987) and longer axial length (OR, 1.310; 95% CI, 1.064-1.611), with no independent links to serum lipids.

These cross-sectional findings demonstrate a significant and subtype-specific association between hyperlipidemia and ARC, particularly regarding PSC severity. While these associative results are exploratory, lipid biomarkers may generate hypotheses for future risk stratification and preventive strategies.