Too much of a good thing: HDL and dementia

It’s been the mantra of cardiovascular health experts for a long time — LDL is “bad” cholesterol and should be kept low, while HDL is the “good” cholesterol that you should have plenty of.

However, the reality is more complicated than that.

While it’s true that optimal HDL levels are important for good cardiovascular health, recent science has shown there can be too much of a good thing. Having higher-than-normal levels of HDL can actually reverse HDL’s heart benefits, as well as increase fracture risk by lowering bone mineral density.

Now a team of researchers in Australia have discovered another downside to too much HDL that should give us all pause….

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HDL and dementia risk

The researchers conducted an analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE), a double-blind, randomized, placebo-controlled trial of daily aspirin in healthy older people. ASPREE recruited 16,703 participants aged 70 years and older from Australia and 2,411 participants aged 65 years and older from the U.S. between 2010 and 2014. Participants had no diagnosed cardiovascular disease, dementia, physical disability or life-threatening illness at enrolment.

Among the 18,668 participants included in this analysis, 2,709 had very high HDL at the beginning of the study. Very high HDL was categorized as 80 mg/dL or above. Optimal heart-healthy HDL levels are considered 40 to 50 mg/dL for men and 50 to 60 mg/dL for women.

The findings were shocking. Over about 6.3 years, participants with very high HDL had a 27 percent higher risk of dementia compared to participants with optimal HDL levels. And those aged 75 and older had a whopping 42 percent increased risk.

These results show a new dementia risk factor for doctors to be aware of, particularly in patients aged 75 or older.

First author and Monash University School of Public Health and Preventive Medicine senior research fellow Dr. Monira Hussain notes that while these findings can help improve the understanding of the mechanisms behind dementia, further research is needed to explain this phenomenon.

“While we know HDL cholesterol is important for cardiovascular health, this study suggests that we need further research to understand the role of very high HDL cholesterol in the context of brain health,” Hussain says.

“It may be beneficial to consider very high HDL cholesterol levels in prediction algorithms for dementia risk,” she adds.

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What causes high HDL?

Another thing the researchers stress is that these very high HDL levels were uncommon and probably not diet-related but more likely reflect a metabolic disorder.

Some disorders tied to high cholesterol include diabetes, kidney disease, polycystic ovary syndrome and underactive thyroid — known as hypothyroidism.

People with hypothyroidism can have high levels of both LDL and HDL. And the condition has been previously connected with an 80 percent dementia risk by researchers at Brown University.

But for most people with moderately high HDL not connected to a specific condition, diet may be able to knock down levels. Some of the same high-fat foods that raise your LDL can also cause an unhealthy spike in HDL levels. These include:

  • Red meat
  • Cream and other full-fat dairy products
  • Butter
  • Cheese
  • Cookies, cakes, and other baked goods
  • Fried foods

Drinking too much alcohol can also raise your HDL, so make sure if you do drink you do so in moderation.

It’s important to remember, as well, that statins raise HDL, though in people with low or normal HDL levels, the increase isn’t considered clinically relevant.

Still, there are reasons that cardiologist Dr. Elizabeth Klodas asks “Should everyone be put on a drug when they reach a certain age?” See her answer to this complex question here

Other medications that can raise HDL levels include birth control pills, hormone replacement therapy for menopause and drugs to prevent seizures.

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Very high levels of ‘good cholesterol’ may be associated with dementia risk: study — Monash University

Surprising Study Links ‘Good’ Cholesterol With Up to 42% Higher Dementia Risk — ScienceAlert

Association of plasma high-density lipoprotein cholesterol level with risk of incident dementia: a cohort study of healthy older adults — The Lancet Regional Health — Western Pacific

Can Good Cholesterol Be Too High? — WebMD

Carolyn Gretton

By Carolyn Gretton

Carolyn Gretton is a freelance writer based in New Haven, CT who specializes in all aspects of health and wellness and is passionate about discovering the latest health breakthroughs and sharing them with others. She has worked with a wide range of companies in the alternative health space and has written for online and print publications like Dow Jones Newswires and the Philadelphia Inquirer.