Association of midlife lipids with 20‐year cognitive change: A cohort study

Abstract

Introduction Existing studies predominantly consider the association of late‐life lipid levels and subsequent cognitive change. However, midlife rather than late‐life risk factors are often most relevant to cognitive health. Methods We quantified the association between measured serum lipids in midlife and subsequent 20‐year change in performance on three cognitive tests in 13,997 participants of the Atherosclerosis Risk in Communities study. Results Elevated total cholesterol, low‐density lipoprotein cholesterol, and triglycerides were associated with greater 20‐year decline on a test of executive function, sustained attention, and processing speed. Higher total cholesterol and triglycerides were also associated with greater 20‐year decline in memory scores and a measure summarizing performance on all three tests. High‐density lipoprotein cholesterol was not associated with cognitive change. Results were materially unchanged in sensitivity analyses addressing informative missingness. Discussion Elevated total cholesterol, low‐density lipoprotein cholesterol, and triglycerides in midlife were associated with greater 20‐year cognitive decline.