The 32-year relationship between cholesterol and dementia from midlife to late life
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Abstract
Background:
Cellular
and animal studies suggest that hypercholesterolemia contributes to
Alzheimer disease (AD). However, the relationship between cholesterol
and dementia at the population level is less clear and may vary over the
lifespan.
and animal studies suggest that hypercholesterolemia contributes to
Alzheimer disease (AD). However, the relationship between cholesterol
and dementia at the population level is less clear and may vary over the
lifespan.
Methods:
The
Prospective Population Study of Women, consisting of 1,462 women
without dementia aged 38–60 years, was initiated in 1968–1969 in
Gothenburg, Sweden. Follow-ups were conducted in 1974–1975, 1980–1981,
1992–1993, and 2000–2001. All-cause dementia was diagnosed according to DSM-III-R
criteria and AD according to National Institute of Neurological and
Communicative Disorders and Stroke–Alzheimer's Disease and Related
Disorders Association criteria. Cox proportional hazards regression
examined baseline, time-dependent, and change in cholesterol levels in
relation to incident dementia and AD among all participants. Analyses
were repeated among participants who survived to the age of 70 years or
older and participated in the 2000–2001 examination.
Prospective Population Study of Women, consisting of 1,462 women
without dementia aged 38–60 years, was initiated in 1968–1969 in
Gothenburg, Sweden. Follow-ups were conducted in 1974–1975, 1980–1981,
1992–1993, and 2000–2001. All-cause dementia was diagnosed according to DSM-III-R
criteria and AD according to National Institute of Neurological and
Communicative Disorders and Stroke–Alzheimer's Disease and Related
Disorders Association criteria. Cox proportional hazards regression
examined baseline, time-dependent, and change in cholesterol levels in
relation to incident dementia and AD among all participants. Analyses
were repeated among participants who survived to the age of 70 years or
older and participated in the 2000–2001 examination.
Results:
Higher
cholesterol level in 1968 was not associated with an increased risk of
AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence
interval [CI] 0.94–8.43) among those who survived to and participated in
the 2000–2001 examination. While there was no association between
cholesterol level and dementia when considering all participants over 32
years, a time-dependent decrease in cholesterol over the follow-up was
associated with an increased risk of dementia (HR 2.35, 95% CI
1.22–4.58).
cholesterol level in 1968 was not associated with an increased risk of
AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence
interval [CI] 0.94–8.43) among those who survived to and participated in
the 2000–2001 examination. While there was no association between
cholesterol level and dementia when considering all participants over 32
years, a time-dependent decrease in cholesterol over the follow-up was
associated with an increased risk of dementia (HR 2.35, 95% CI
1.22–4.58).
Conclusion:
These
data suggest that midlife cholesterol level is not associated with an
increased risk of AD. However, there may be a slight risk among those
surviving to an age at risk for dementia. Declining cholesterol levels
from midlife to late life may better predict AD risk than levels
obtained at one timepoint prior to dementia onset. Analytic strategies
examining this and other risk factors across the lifespan may affect
interpretation of results.
data suggest that midlife cholesterol level is not associated with an
increased risk of AD. However, there may be a slight risk among those
surviving to an age at risk for dementia. Declining cholesterol levels
from midlife to late life may better predict AD risk than levels
obtained at one timepoint prior to dementia onset. Analytic strategies
examining this and other risk factors across the lifespan may affect
interpretation of results.
GLOSSARY
- AD
- = Alzheimer disease;
- BMI
- = body mass index;
- CI
- = confidence interval;
- DBP
- = diastolic blood pressure;
- DSM-III-R
- = Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised;
- HR
- = hazard ratio.
