Research has found that remnant cholesterol serves as an independent risk factor for dementia in people with type 2 diabetes (T2D), with the risk more pronounced in 40- to 49-year-olds compared to older age groups. These findings highlight the profound impacts of high cholesterol on the brain and raise important questions about how clinicians approach cholesterol management. A session at the European Association of the Study of Diabetes Annual Meeting this week in Hamburg did a deep dive into the research.

High cholesterol is a silent ailment, often lurking symptomless. Its diagnosis predominantly happens in older age, with treatment mostly revolving around lifestyle changes and medications. Despite the subtlety of its presence, the impact of high cholesterol is profound, affecting not only the heart but putting the health of the brain on the line too, especially for younger people with T2D.

Recent research has put a spotlight on the relationship between remnant cholesterol levels and dementia. “Remnant cholesterol accounts for one-third of total cholesterol and 50% of the cholesterol responsible for atherosclerotic events, including those leading up to dementia,” explained Han Na Jung of Hallym University College of Medicine, Korea, at the European Association of the Study of Diabetes Annual Meeting held this week in Hamburg, Germany.

Remnant cholesterol is measured as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Jung’s latest research – the first population-based study examining the link between remnant cholesterol and dementia in T2D – has shown that remnant cholesterol serves as an independent risk factor for dementia in patients with T2D.

“The direct relationship between remnant cholesterol and Alzheimer’s disease is not yet known,” said Jung. However, she further explained, “In patients with type 2 diabetes and dyslipidaemia, Alzheimer’s disease is accelerated greater than in those with just one entity, suggesting that the risk of dementia may be potentiated in individuals with type 2 diabetes and high remnant cholesterol levels.”

Interestingly, the study found that the risk of dementia was more pronounced with higher remnant cholesterol levels in 40- to 49-year-olds compared to older age groups. “The risk of dementia in individuals under 40 years old was too low to factor into the study,” said Jung. Though the reason for this amplified risk in the 40- to 49-year-old demographic remains a point of further investigation, Jung told Univadis.com that the factors contributing to this could be that “older individuals typically have other risk factors that influence dementia greater than remnant cholesterol, and so cholesterol alone may not be a specific enough risk factor for them.”

Without direct symptoms of high cholesterol, many younger individuals remain unaware of their elevated levels until more pronounced health issues manifest. Should the medical community then advocate for earlier testing and more aggressive campaigns aimed at younger demographics? The study's findings might indeed suggest so.

“We absolutely have to determine cholesterol levels in all patients, not just in those with diabetes,” Jung remarked. “All clinicians must follow guidelines and provide treatment for all eligible patients using available therapies.”

Traditionally, the primary concern with high cholesterol has been its direct link to atherosclerosis. But given the profound relationship between high remnant cholesterol and dementia, there's a strong argument for dementia to join the list of potential consequences physicians discuss with their patients.

The study's revelation about the pronounced risk in the younger age group further accentuates the necessity of early intervention. Not only does this discovery open up a dialogue about the necessity of early cholesterol testing, but it also pushes practitioners to rethink cholesterol management strategies – and in some regard, awareness – for younger individuals.

While further research is necessary to fully understand the cholesterol-dementia link, one thing is clear: cholesterol's impact on the brain is profound, and it's a health concern that cannot be overlooked. Those with or at risk of T2D should be proactive in understanding their cholesterol levels and the potential risks associated with dyslipidaemia, and clinicians should tailor their approach to T2D treatment to hone further into lipid management.

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EASD 2023 – Remnant Cholesterol Increases Dementia Risk in Type 2 Diabetes

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