Relationship between low-and high-density lipoprotein cholesterol and cognitive decline in elderly Chinese population

ZHANG Zihan; QIN Yanwen

doi:10.3969/j.issn.1009-0126.2026.02.018

Abstract：Objective To investigate the influence of low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)and the ratio(LDL-C/HDL-C)on cognitive function in elderly Chinese individuals.Methods Chinese Longitudinal Healthy Longevity Survey(CLHLS)cohort was subjected to derive the data from 4 waves of survey during November 2008 and September 2018.Finally,1081 individuals were enrolled in this study.Cognitive function was assessed using Mini-Mental State Examination(MMSE),and all the participants were divided into an accelerated cognitive decline group(participants who initially exhibited a decline in MMSE score by>2 between a follow-up and baseline,125 cases)and cognitive stability group(956 cases).At baseline,serum levels of LDL-C and HDL-C were measured,and the LDL-C/HDL-C ratio was calculated.After the last follow-up,restricted cubic splines were used to describe the dose-response relationships,Cox proportional hazards regression models were employed to determine the effects of LDL-C,HDL-C,and the LDL-C/HDL-C ratio on the risk of accelerated cognitive decline,and sensitivity analysis was performed to evaluate the robustness of the model.Results The accelerated cognitive decline group exhibited significantly older baseline age,lower male ratio,shorter years of education,and fewer smokers at baseline when compared with the cognitive stability group(P<0.05,P<0.01).At the last follow-up,the scores in the dimensions of general capacity,response,attention and calculation,memory,language,and self-coordination were obviously lower in the accelerated cognitive decline group than the cognitive stability group(P<0.01).The results of restricted cubic spline analysis showed a positive correlation between LDL-C and HDL-C ratio and risk of accelerated cognitive decline,while HDL-C level was negatively correlated with the risk of accelerated cognitive decline.After adjusting for relevant factors,Cox proportional hazards regression analysis indicated that LDL-C/HDL-C ratio was a risk factors for accelerated cognitive decline(HR=1.18,95%CI:1.04～1.34),and HDL-C level was a protective factor for cognitive function(HR=0.58,95%CI:0.42～0.80).The results of sensitivity analyses were consistent with the main findings,indicating the robustness of the model(P<0.05).Conclusion An elevated LDL-C/HDL-C ratio is a risk factor for accelerated cognitive decline in the elderly,while higher HDL-C level has protective effect.