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Risk of dementia increases with elevated levels of residual cholesterol
Last reviewed: 02.07.2025
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In a recent study published in The Lancet Healthy Longevity, researchers examined how remnant cholesterol (remnant-C) levels are associated with the risk of developing dementia using a large dataset from South Korea.
Their results show that higher remnant cholesterol concentrations are associated with an increased risk of dementia of any cause, vascular dementia, and Alzheimer's disease, suggesting that managing and monitoring these levels may be important in reducing the risk of dementia.
As the population ages, prevention of dementia becomes increasingly important, especially since many risk factors can be modified. Up to 40% of dementia cases are associated with factors such as diabetes, hypertension, obesity and dyslipidemia.
Dyslipidemia refers to abnormal levels of lipids, such as cholesterol and triglycerides, in the blood. Triglycerides are fats found in the blood, and elevated levels can increase health risks.
Lipoproteins are particles that transport cholesterol and triglycerides in the bloodstream. High levels of these fats and lipoproteins, especially remnant cholesterol, are associated with increased risks of vascular dementia and Alzheimer's disease.
The aim of the study was to examine how remnant cholesterol levels are associated with the risk of developing dementia using data from South Korea's National Health Service (NHIS), which covers almost the entire population of the country.
The researchers focused on people aged 40 and older who took part in a national health survey in 2009.
The study excluded people under 40 years of age, those with very high triglyceride levels, those with existing diagnoses of dementia, and those with missing data.
The researchers collected detailed demographic and lifestyle information using standardized questionnaires and medical examinations. They measured various health indicators, including lipid profiles, body mass index (BMI), and blood pressure.
The primary outcome was the development of dementia, which was tracked using medical records and dementia-related medication prescription data.
The study analyzed the association between remnant cholesterol levels and the likelihood of developing Alzheimer's disease, vascular disease, and dementia of any cause, taking into account factors such as age, gender, smoking, alcohol consumption, physical activity, income, and comorbidities.
The researchers used statistical methods including Kaplan-Meier analysis and Cox proportional hazards models to assess differences in risk across quartiles of remnant cholesterol.
The study analyzed data from 2,621,596 adults, about equal numbers of men and women, to examine the association between remnant cholesterol levels and dementia risk.
Participants were divided into four groups (quartiles) based on their remnant cholesterol levels. Those in the highest quartile were more likely to be men and had poorer health indicators, including higher body mass index, triglycerides, fasting glucose, blood pressure, and lower high-density lipoprotein (HDL) cholesterol. They were also more likely to smoke, drink alcohol heavily, and engage in less physical activity.
The median follow-up time was 10.3 years, during which time 5.6% of participants had dementia of any cause, 4.5% Alzheimer's disease, and 0.6% vascular dementia. The risk of developing dementia increased with increasing remnant cholesterol levels.
People in the highest quartile were 11% more likely to develop dementia from any cause, 11% more likely to develop Alzheimer's disease, and 15% more likely to develop vascular dementia compared with those in the lowest quartile. The increased risk was greater in younger participants and those with diabetes, particularly those with longer disease duration.
The study results show that high remnant cholesterol levels are significantly associated with an increased risk of vascular dementia, Alzheimer's disease, and dementia of any cause, independent of total cholesterol levels and the use of lipid-lowering medications.
The risk is particularly high for vascular dementia and is more pronounced in middle-aged people and those with diabetes, especially those with long-standing disease.
These results highlight the importance of monitoring remnant cholesterol levels as a potential marker of dementia risk, particularly in high-risk groups.
Strengths of the study include its large sample size and long follow-up period. However, limitations include potential confounding factors, lack of data on educational attainment, and failure to account for apolipoprotein E (APOE) genotype, which is a strong risk factor for dementia.
Future studies should explore the mechanisms linking remnant cholesterol (remnant-C) to dementia and consider genetic factors, as well as long-term monitoring of remnant cholesterol levels to develop early intervention strategies.