New Research Shows High HDL Cholesterol is Associated with an Increased Risk of Dementia

It has been well established that cardiovascular risk is lower when high-density lipoprotein cholesterol (HDL-C) is elevated. In 2021, the Journal of Lipid and Atherosclerosis featured a large-scale nationwide cohort study featuring 343,678 individuals which concluded that even extremely high HDL-C levels were protective and that the higher the HDL-C level, the lower the risk of cardiovascular mortality and myocardial infarction.

A new study, however, featured in the Lancet highlights a potential flaw in focusing on high HDL-C as it shows a direct association between elevated HDL-C and increased risk of dementia. With all-cause dementia as the primary endpoint, this post-hoc analysis of 16,703 participants aged 70 or older and 2,411 participants aged 65 or younger found that there was an increased risk of all-cause dementia in individuals with high HDL-C levels, especially in adults aged 70 or older.

“I have long believed that we should not automatically assume that elevated HDL-C is a good thing,” said naturopathic cardiology expert Daniel Chong, ND. “From an integrative standpoint, simply relying on the standard cholesterol panel does not fully determine how a patient is doing from a cardiovascular disease risk standpoint.”

Based on the research, Chong feels diet plays a significant role as it directly impacts HDL-C. He cites research showing that a diet high in saturated fat, for example, impairs the anti-inflammatory activity of high-density lipoproteins and can also create oxidative stress and further harm HDL function.

The Statin Approach

Statin drugs are considered first-line treatment when it comes to addressing high cholesterol. Research indicates that one of the previously believed benefits of these drugs is that in addition to lowering LDL/apolipoprotein B (ApoB), they also cause modest increases in HDL-C, which may now become an adverse effect given the results from the Lancet study.

In addition, research is clear that long-term statin use is associated with several side effects, including myalgia, hepatic dysfunction, diabetes, peripheral neuropathy, mood issues, and cognitive impairment. Statins also have multiple potential drug interactions that need to be carefully monitored.

“In general, I do not feel statins are an appropriate first-line intervention for primary prevention unless the LDL/ApoB levels are very high and the patient is not willing to make any changes to improve their health, which may be all that is needed,” explained Chong, a clinician with BioLounge in Portland, Ore. Chong also uses genetic testing to help determine if there is an increased likelihood of statin-induced toxicity and to help the patient select the appropriate statin if one is needed. 

“Short-term use of statins should almost always be considered for secondary prevention post-stent or post-heart attack because of their positive effects on plaque stability, endothelial function, and inflammation,” he said.

The Integrative Cardiology Approach

“Cardiovascular health is very nuanced with many factors to consider, including the patient’s genetics, degree of cardiovascular disease, gender, other health aspects, and their willingness/capacity to make lifestyle changes,” said Chong.

For Chong, making necessary dietary changes is key and foundational to his approach. He teaches his patients to reduce processed foods and saturated fats while increasing fiber, phytonutrients, and essential fatty acids.

“Lifestyle factors such as sleep quality, stress levels, and physical activity can also make a difference, although typically less potently than diet,” he said. “Dietary supplements can help but I never start with supplements without first having the patient make appropriate diet and lifestyle changes.”

How does the integrative strategy impact HDL-C? “Interestingly, I have found that when dietary changes are made, I often see a drop in LDL and HDL, to a lesser degree, which I consider to be a good sign, especially in light of this latest research,” he said.