High Dementia Risk Associated With ‘Good Cholesterol,’ Research Says

Often dubbed the “good cholesterol” due to its cardiovascular benefits, high-density lipoprotein (HDL) cholesterol has been linked to a surprising risk—dementia. Recent studies suggest that very high levels of HDL, far from being entirely beneficial, might increase the risk of developing cognitive decline in older adults.¹

The Study on HDL and Dementia Risk

A study published in The Lancet Regional Health followed 18,668 healthy adults aged 65 or older for over six years to explore the potential relationship between HDL levels and dementia. During this time, 850 participants developed dementia, and the results showed that individuals with HDL levels above 80 mg/dL were at a significantly higher risk. This counters the long-held belief that higher HDL is always protective for brain and heart health.

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Elevated Risk with High HDL Levels

According to the study, individuals aged 75 and older with very high HDL levels experienced a 42% higher likelihood of developing dementia compared to those with optimal HDL levels. Even among younger participants, high HDL increased dementia risk by 27%.² This alarming connection underscores the need to rethink HDL cholesterol’s role in overall health, particularly in aging populations.

Why High HDL Might Be Harmful

Researchers are still exploring why high levels of HDL cholesterol may be linked to dementia. HDL cholesterol helps clear “bad” cholesterol from the bloodstream, but at excessive levels, its structure and function may change, leading to potentially harmful effects, such as vessel stiffening or inflammation in the brain.³ Some experts believe that very high HDL can become pro-inflammatory, contributing to neurological damage.

HDL’s Different Role in the Brain

HDL functions differently in the brain compared to the rest of the body. High levels of HDL in the brain may increase the risk of stroke—a major risk factor for dementia. Additionally, HDL particles may trigger amyloid production in the brain, which is associated with Alzheimer’s disease.⁴ These findings suggest that while HDL is helpful in moderation, extreme levels may contribute to cognitive decline.

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Not Just About Cholesterol

What makes this finding more complex is that traditional dementia risk factors like physical activity, alcohol consumption, smoking, and even genetic predisposition were adjusted for, yet the increased risk from high HDL levels remained significant. This highlights that HDL cholesterol is far more complicated than a simple “good vs. bad” dynamic, especially when considering brain health.

Should You Be Concerned About HDL Levels?

Although HDL is generally beneficial, this research suggests that extremely high levels could be a concern for aging individuals. Experts stress that further studies are needed to understand the full picture, but managing HDL within recommended ranges may be key. As the lead author of the study remarked, “The relationship between HDL cholesterol and dementia is more complex than we previously thought.”.

Rethinking HDL’s Role in Health

In light of this new research, it may be time to rethink HDL cholesterol’s “good” status. While it plays a crucial role in cardiovascular health, extremely high levels might pose unexpected risks, particularly for cognitive health in older adults. Monitoring and maintaining balanced cholesterol levels could help reduce the risk of dementia, though more studies are necessary to confirm these findings.

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