High LDL cholesterol may protect against dementia – don’t tell the statin pushers!

Don’t tell the statin brigade, but elevated LDL cholesterol may actually help us as we age!

new study from China suggests that those with higher levels of LDL-C have a lower incidence of dementia. They evaluated 3,800 subjects with a mean age of 69 years, performing extensive neuropsychological and cognitive ability testing. They found that the diagnosis of dementia and cognitive impairment correlated with increasing age, decreasing education level, diagnosis of type 2 diabetes, and being an ApoE4 carrier. After controlling for all these factors, they also found that those in the highest tertile of LDL-C (>142 mg/dL or 3.7 mmol/L) had a 50% lower incidence of dementia than those in the lowest tertile (<110 mg/dL or 2.9 mmol/L).

Frontiers in Neurology: High low-density lipoprotein cholesterol inversely relates to dementia in community-dwelling older adults: The Shanghai aging study

These findings are consistent with a prior study (also observational) examining the Framingham Heart Study data that found lower risk of dementia in those over 85 years old with higher cholesterol levels.

In fairness, these studies were observational studies, so they do not prove higher LDL-C directly protected against dementia. We can hypothesize why higher levels of LDL-C are associated with lower incidence of dementia. It could be a marker of overall health or nutritional status, it could be that LDL-C directly improves the health of neurons and prevents brain atrophy, or it could be more related to lack of diabetes or ApoE4 status for which a study may not always completely control.

Even without proving causation, these studies are wonderful reminders that we can easily get caught up in one specific disease processes (i.e. cardiovascular disease) and forget about the rest of the patient. The old joke is that when the surgeon talks to the family after a complicated and risky coronary bypass surgery, he says, “The surgery was a great success. The grafts were perfect, and the anastomosis were flawless, some of the best I have ever done. I’m sorry the patient died, but the surgery was wonderful.”

This is a fictional over-exaggeration, but it makes my point.

Cholesterol’s effects on our health are far too intricate to simply label LDL-C as “bad” and leave it at that. Such oversimplifications harm our overall understanding and eventually harms our health.

Instead, we need to focus on the whole patient, not one specific outcome. Trials should focus on all-cause mortality and overall morbidity rather than one or two specific outcomes. It doesn’t do us much good to lower heart attack risk by 0.5% over five years if we are also increasing the risk of dementia, cancer or other complications.

Thanks for reading,
Bret Scher MD FACC


Originally Posted on the Diet Doctor Blog 

2 thoughts on “High LDL cholesterol may protect against dementia – don’t tell the statin pushers!”

  1. Hi Dr. Scher,

    I find you Youtube videos very educational.

    I live in Vancouver BC and was diagnosed with diabetes a year ago. I then started LCHF, lost 12 lbs; but my recent blood test shows higher LDL levels. As a result, my family doctor and cardiologist are pushing me to start taking statin. Below are my numbers:

    • Male • 56 • Coffee: 1.5 cups/day •
    • 10 on months on LCHF (20g to 120g carbs) •
    • 12h water fasted • Cholesterol Rx: false •

    Total Cholesterol: 234 mg/dL 6.06 mmol/L
    LDL Cholesterol: 161 mg/dL 4.17mmol/L
    HDL Cholesterol: 60 mg/dL 1.54mmol/L
    TG Cholesterol: 68 mg/dL 0.77mmol/L
    a1c: 5.9

    It’s discouraging that these doctors that I’m dealing with are all still using the old risk assessment model that focuses on LDL. I’ve not been able to find a physician in my area that adopts LCHF/focuses on insulin resistance. Any advise that you can provide?

    Also, does CAC score change the cvd risk, given the same lipid profile? I’m asking my doctor to give me a referral for a heart scan.

    Thank you!

    1. Hi Adam,

      Thank you for your thoughtful response!

      Unfortunately, Dr. Scher is unable to give medical advice on his blog. If you would like a more detailed evaluation and answer to your questions, you could always consider an individualized consult or, since you live in Canada, it may make the most sense for you to sign up for his 6-month Boundless Health Program.

      Dr. Scher also offers a Lipids program, which may be more precise in terms of what you are looking for. It’s a part of the 6 Month Boundless Health Program, but if that’s what you’re looking for specifically, may make more sense if taken as a standalone.

      I really hope this helps, Adam!

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Bret Scher, MD FACC

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