6d • General discussion
High cholesterol in your 40s damages the brain. Silent. Invisible. Setting the stage for dementia 30 years later.
The 2024 Lancet Commission added high LDL cholesterol to the list of modifiable dementia risk factors.
First time ever.
Here's what happens:
High cholesterol in midlife (40s-50s) damages small blood vessels feeding your brain.
Creates atherosclerosis in cerebral arteries.
Reduces blood flow to brain tissue.
Causes microinfarcts - tiny strokes you never feel.
White matter disease - visible on MRI but silent.
All accumulating over 20-30 years.
By age 70: brain riddled with vascular damage.
Memory problems start. Cognitive decline accelerates.
Diagnosed with "mixed dementia" - Alzheimer's plus vascular disease.
But the vascular part started at 45.
The vascular-inflammation connection:
Damaged blood vessels trigger chronic inflammation.
Brain's immune cells stay activated.
This inflammation accelerates amyloid and tau accumulation.
Vascular damage + inflammation = faster cognitive decline.
What counts as high:
- LDL >130 mg/dL (optimal <100, ideally even lower).
- Total cholesterol >200 mg/dL.
Many people in their 40s have these levels.
No symptoms. Feel fine.
Doctor says "borderline high, let's watch it."
Meanwhile: 20 years of silent damage starting.
The numbers:
Vascular dementia: 15-20% of all dementia.
Mixed dementia (vascular + Alzheimer's): another 20-30%.
Nearly half of all dementia has vascular component.
Much of it preventable.
What works:
- Statins lower cholesterol 30-50%.
- Mediterranean diet reduces cholesterol naturally (lots of nutritional and non-prescription options).
- Exercise improves vascular health.
- Blood pressure control critical.
The timing:
Starting treatment at 45: prevents decades of damage.
Starting at 70: damage already done.
Can slow progression but can't undo past harm.
The missed opportunity:
Millions in their 40s-50s with untreated high cholesterol.
Thinking: "I'm too young for this."
Not realizing dementia risk starts in midlife.
What I tell patients:
Your brain has tiny blood vessels everywhere.
High cholesterol slowly damages them.
Like rust on pipes - invisible until failure.
We can prevent the rust. Only if we start early.
Check cholesterol by 35. Repeat every 5 years.
If elevated: treat it.
Think brain protection, not just heart protection.
Your cognitive health at 75 depends on vascular health at 45.
💬 Do you know your cholesterol level?
Citations: Livingston G et al. (2024). Dementia prevention, intervention, and care: 2024 Lancet Commission report.
P.S. Happy Holidays!
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High cholesterol in your 40s damages the brain. Silent. Invisible. Setting the stage for dementia 30 years later.
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