Mid-life cholesterol and dementia risk

I have high cholesterol and my doctor wants me to take statins. I'm 55 and feel fine – is it really worth it, and does it have anything to do with dementia?

It does have something to do with it, and the age of the question is relevant: WHO guidelines specifically highlight mid-life as the time when managing cholesterol matters for the risk of dementia decades later.

What the WHO says

Dyslipidaemia (altered cholesterol and blood fats) management should generally be offered, according to established guidelines. Specifically, to reduce the risk of cognitive decline and dementia, the guidelines state that dyslipidaemia management in mid-life can be offered (conditional recommendation, low certainty). The rationale is the same for the entire vascular family: high cholesterol contributes to the narrowing and hardening of arteries – including those that supply the brain.

"I feel fine" – the classic problem

High cholesterol doesn't cause symptoms. Neither does high blood pressure, nor high sugar in the initial stages. It's the silent trio: when you "feel" it, it's already in the form of a heart attack, stroke – or, decades later, contributing to vascular dementia. Treating without symptoms is precisely the idea of prevention.

About statins

The decision to medicate considers your overall cardiovascular risk – not just the cholesterol number – and is a conversation to have with your doctor, including any concerns about side effects (most people tolerate them well; if there are complaints, there are alternatives and adjustments). What's not a good idea is to indefinitely postpone a decision your doctor considers important, based solely on "I feel fine".

What you can do besides (or before) pills

A diet with fewer saturated fats and processed foods, more fish and olive oil, regular exercise, and not smoking – all affect cholesterol and, more importantly, overall risk. If you prefer to first try a few months of lifestyle changes before medication, openly suggest it to your doctor with a new test scheduled: it's a legitimate strategy when the risk allows it – but they are the one to assess that.