A new study has found that high levels of HDL cholesterol—often called the “good” cholesterol—may be linked to a higher risk of Alzheimer’s disease in postmenopausal women.
This finding is surprising because HDL cholesterol is usually seen as something that protects the heart. But researchers now believe the story is more complicated, especially as women grow older.
The study, published in The Journal of Clinical Endocrinology & Metabolism, was led by scientists at the University of Pittsburgh School of Public Health. The team looked at the health data of 503 women who were part of a long-term research project called the Study of Women’s Health Across the Nation (SWAN).
The study followed these women from 2000 to 2016 and tracked changes in their cholesterol levels and memory performance.
The researchers found that after menopause, HDL cholesterol changes in ways that may not be helpful for brain health. Specifically, they learned that it’s not just the amount of HDL that matters, but the type and quality of the HDL particles.
HDL particles come in different sizes and types. Some are small and rich in molecules called phospholipids, which help keep brain cells healthy. Others are larger but don’t work as well.
Over time, women in the study developed more of the large HDL particles and fewer of the small, high-quality ones. The women with more of the small, phospholipid-rich HDL particles were more likely to have better memory as they aged. On the other hand, women with more large HDL particles seemed to be at greater risk of cognitive decline.
Dr. Samar R. El Khoudary, the lead researcher and a professor of epidemiology, explained that the first signs of Alzheimer’s often show up as problems with memory. Her team’s findings suggest that changes in cholesterol after menopause might play a role in this process.
Although this sounds concerning, there is also hope. Dr. El Khoudary and her team point to earlier research showing that healthy lifestyle habits can improve the quality of HDL cholesterol.
Following guidelines like the American Heart Association’s Life’s Essential 8—such as exercising regularly, keeping a healthy weight, eating well, and not smoking—can make HDL particles more effective. These habits may not lower your HDL-C levels, but they can improve how well those particles protect your heart and brain.
The study’s first author, Dr. Meiyuzhen Qi, worked with a large team from several universities, including the University of Pennsylvania, UCLA, and the University of Michigan. Their work adds to a growing body of research showing how heart health and brain health are closely connected—especially for women going through menopause.
The takeaway from this study is that it’s not enough to simply have high HDL cholesterol. As we age, we also need to make sure those HDL particles are still doing their job. And the best way to do that is through healthy habits, ideally starting in your 40s or earlier.
So while HDL is still important, the type and function of HDL matter more than just the number. By focusing on exercise, healthy eating, and avoiding smoking, women may be able to protect both their hearts and their minds as they age.
This research also encourages more people to look into the causes of Alzheimer’s and explore non-drug options for prevention. Many new studies suggest that changes in diet and lifestyle could help prevent or slow down memory loss. Some even show that about 40% of dementia cases could be prevented by changing certain health and lifestyle factors.
In short, looking after your brain health may begin with how you care for your heart—and that includes paying attention to the kind of cholesterol your body is producing as you get older.
If you care about Alzheimer’s disease, please read studies about the protective power of dietary antioxidants against Alzheimer’s, and eating habits linked to higher Alzheimer’s risk.
For more health information, please see recent studies that oral cannabis extract may help reduce Alzheimer’s symptoms, and Vitamin E may help prevent Parkinson’s disease.
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