High LDL Cholesterol and Dementia Risk: What We Know.
- Remy Mathi
- Aug 15
- 5 min read
Post written by Remy Mathi, during his fourth year as a medical student at Campbell University School of Osteopathic Medicine
Cholesterol is an essential molecule that serves many functions within the human body. It provides structure to our cell membranes and is needed to make hormones, vitamin D, and bile acids. Cholesterol is often discussed in the context of cardiovascular health, but emerging research suggests that cholesterol levels, particularly during midlife, may also have important implications for brain health and cognitive function.
To understand cholesterol, it helps to know how the body transports it. If you have ever had bloodwork done at your physician’s office, you may have noticed terms such as LDL, HDL, and VLDL on your lipid panel. These lipoproteins are particles that transport cholesterol and other fats through the bloodstream.
LDL (Low-Density Lipoprotein)
LDL is commonly called “bad cholesterol.” LDL particles transport cholesterol through the bloodstream to tissues throughout the body. When LDL cholesterol levels are elevated, cholesterol can accumulate in artery walls and contribute to atherosclerotic plaque formation. Over time, this can increase the risk of cardiovascular disease and stroke.
HDL (High-Density Lipoprotein)
HDL is commonly called “good cholesterol.” HDL helps transport cholesterol from peripheral tissues back to the liver, where it can be processed and removed from the body. While higher HDL levels have historically been associated with lower cardiovascular risk, we now know that the relationship is more complicated and that HDL levels alone do not determine cardiovascular risk.
VLDL (Very Low Density Lipoprotein)
The liver produces VLDL, which primarily transports triglycerides through the bloodstream. As VLDL particles lose triglycerides, they are eventually converted into LDL particles.
Learn more about cholesterol at GeriAcademy - Cholesterol: it's more than just a number!
Why Should You Care About Cholesterol and Brain Health?
The 2024 Lancet Commission on dementia prevention, intervention, and care added high LDL cholesterol in midlife to its list of potentially modifiable risk factors for dementia.⁴ This is important because many of the changes that eventually affect brain health can begin years or even decades before someone develops symptoms of cognitive decline.
High LDL cholesterol contributes to atherosclerosis and vascular disease. The brain depends on a healthy blood supply, and blood vessel damage can contribute to stroke, cerebral small vessel disease, and vascular cognitive impairment. Vascular disease may also occur alongside Alzheimer’s disease and other causes of dementia.
Research has demonstrated an association between elevated LDL cholesterol and dementia risk. However, an association does not necessarily mean that lowering LDL cholesterol will directly prevent dementia. Researchers are continuing to study whether LDL lowering itself reduces the incidence of dementia and how factors such as the age at which treatment begins may influence that relationship.
Even with these unanswered questions, the Lancet Commission recommends detecting and treating high LDL cholesterol beginning in midlife as part of a broader approach to reducing dementia risk.
So what can you do to improve your LDL cholesterol?
Lifestyle and Nutrition
Dietary changes can meaningfully affect LDL cholesterol levels. One of the most effective dietary strategies is replacing foods high in saturated fat with foods containing unsaturated fats.²˒⁶
Common sources of saturated fat include:
• Butter, beef tallow, and lard
• Coconut and palm oils
• Full-fat dairy products
• Red and processed meats
Healthier alternatives include:
• Olive oil
• Nuts and seeds
• Fish
• Beans and other legumes
• Whole grains
• Fruits and vegetables
• Low-fat dairy or plant-based alternatives
Rather than focusing on whether a diet is specifically vegan, vegetarian, or another label, the overall quality of the diet is important. Dietary patterns that emphasize plants, nuts, legumes, whole grains, soluble fiber, and unsaturated fats have been associated with improvements in LDL cholesterol.
A Mediterranean or plant-predominant eating pattern is one way to incorporate many of these foods while supporting both cardiovascular and overall health.
Exercise and Physical Activity
Regular physical activity is another important part of cardiovascular and brain health. Current recommendations include at least 150 minutes per week of moderate-intensity aerobic physical activity or 75 minutes per week of vigorous-intensity aerobic activity, along with resistance training at least two days per week.
Moderate intensity activities may include:
• Brisk walking
• Leisure swimming
• Cycling
• Gardening or yard work
Vigorous activities may include:
• Jogging or running
• Lap swimming
• Rowing
• Higher intensity cycling
Resistance exercise may include:
• Free weights
• Weight machines
• Resistance bands
• Push-ups, squats, lunges, and other bodyweight exercises
For many people, 150 minutes per week can be achieved with about 30 minutes of moderate activity five days per week. It does not have to happen all at once. Incorporating physical activity consistently into your routine can support cardiovascular health and may also help protect brain health as we age.
Medications
Sometimes lifestyle changes are not enough to lower LDL cholesterol adequately. Genetics, age, medical conditions, and an individual’s baseline cardiovascular risk can all influence cholesterol levels and determine whether medication is appropriate.
Statins, including medications such as atorvastatin and rosuvastatin, remain the foundation of pharmacologic LDL lowering for many patients who require treatment.
High-intensity statin therapy can reduce LDL cholesterol by 50 percent or more.
Some individuals may need additional medications to reach an appropriate LDL cholesterol level. Options can include ezetimibe, bempedoic acid, and PCSK9 targeted therapies. The appropriate medication and LDL goal depend on a person’s medical history, cardiovascular risk, family history, other health conditions, and ability to tolerate treatment.
Work with your physician to determine an individualized treatment plan rather than focusing on a single cholesterol number.
What Does This Mean for Your Brain?
The connection between cardiovascular health and brain health is becoming clearer. The 2024 Lancet Commission now recognizes high LDL cholesterol in midlife as a potentially modifiable risk factor associated with dementia.
This does not mean that everyone with high LDL cholesterol will develop dementia, nor does it mean that lowering LDL cholesterol guarantees that dementia can be prevented. Dementia develops through a complex combination of age, genetics, vascular health, lifestyle, and other medical factors. The evidence does tell us that midlife matters.
Identifying and treating high LDL cholesterol, remaining physically active, eating a nutrient-rich diet, controlling other cardiovascular risk factors, and working with your physician when medication is appropriate are practical steps we can take today to support cardiovascular and brain health across the lifespan.
Medical Disclaimer: This article is for educational and informational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Individual health needs and treatment decisions vary. Please consult your physician or other qualified healthcare professional before changing your medications, diet, exercise routine, or medical care.
References
Schade DS, Shey L, Eaton RP. Cholesterol Review: A Metabolically Important Molecule. Endocrine Practice. 2020;26(12):1514–1523. doi:10.4158/EP20200347.
Ference BA, et al. Impact of Lipids on Cardiovascular Health. Journal of the American College of Cardiology. 2018;72(23):2980–2995. doi:10.1016/j.jacc.2018.10.021.
Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation. 2026;153(17):e1154–e1276. doi:10.1161/CIR.0000000000001423.
Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024;404:572–628.
Zimmerman SC, Choi M, Jiang C, et al. Statin Initiation and Dementia Incidence in a Large Health Care System From 1997 to 2020: A Target Trial Emulation Study. Neurology. 2025;105(2):e213855. doi:10.1212/WNL.0000000000213855.
Lichtenstein AH, Khera A, Anderson CAM, et al. 2026 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2026;153(18):e1285–e1295.
Comments