What is the clinical evidence from this study?

Study design: Cohort. Population: Cognitive impairment and depression (n=4302). Intervention: Baseline cognitive impairment and depression vs. Higher baseline cognitive function and lower depression severity. Primary outcome: Follow-up HDL-C levels (β = -0.036, p=<0.01).

September 9, 2024Lipids in Health and Disease14 citationsOpen Access

Cognitive impairment and depression precede increased HDL-C levels in middle-aged and older Chinese adults: cross-lagged panel analyses

Q: What are the key findings of this study?

Baseline cognitive impairment and greater severity of depression were significantly associated with increased HDL-C levels 4 years later, whereas higher baseline HDL-C did not predict future cognitive performance.

YLYihui LiuEast China University of Science and Technology MCMu-Tong ChenShantou University YHYong‐Yi HeSun Yat-sen University

Key Result

Baseline cognitive impairment and greater severity of depression were significantly associated with increased HDL-C levels 4 years later, whereas higher baseline HDL-C did not predict future cognitive performance.

Study Design

Type

Cohort (n=4,302)

Multicenter

Yes

Structured PICO

Population

4,302 middle-aged and older Chinese adults aged 45 years and above were followed for 4 years to assess the temporal relationships among cognitive function, depressive symptoms, and HDL-C levels.

Outcome

Temporal sequence and associations between HDL-C levels, cognitive performance (global cognition, episodic memory, mental intactness), and depressive symptoms at 4 years follow-up.

Cognitive impairment and depression precede increased HDL-C levels, challenging the notion that higher HDL-C is universally protective against cognitive decline.

Main Result

Effect estimate: β = -0.036

p-value: p=<0.01

Limitations

Response rate for individuals completing both blood tests and cognitive assessments was 74%, potentially influencing accuracy.
HDL levels represent HDL-C rather than the functional components of HDL such as proteins and enzymes.
Unmeasured confounding factors such as dietary intake and physical activity levels were not accounted for.
Lack of detailed information on alcohol use, such as concentration, daily consumption, and frequency.
Dataset may not account for familial genetic variations or mutations that could contribute to elevated HDL levels.

Abstract

BACKGROUND: High-density lipoprotein cholesterol (HDL-C) is widely recognized for its protective effects against cognitive decline. However, recent studies have presented conflicting results, with some suggesting no significant cognitive benefits or even an increased risk of dementia associated with high HDL-C levels. For those who suffer from depression, the cognitive benefits of HDL-C may be diminished or reversed. The purpose of this study is to investigate the associations between HDL-C, cognitive ability, and depressive symptoms in middle-aged and older Chinese adults. METHODS: The datasets utilized were sourced from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011 and 2015, comprising 4,302 participants. Cross-lagged models were employed to explore the temporal sequence between cognitive performance and HDL-C levels, and to examine the interplay among depression, cognition, and HDL-C. Confounding factors such as sociodemographic characteristics, sleep conditions, and history of chronic diseases were controlled for. RESULTS: The analysis revealed unidirectional effects of baseline impaired cognition and greater severity of depression on increased HDL-C levels at follow-up (β = - 0.036 and β = 0.028, respectively, P 0.05). Depressive symptoms and cognition were found to have a significant bidirectional association (β = - 0.026 and β = - 0.053, respectively, P < 0.05). CONCLUSIONS: Cognitive impairment and depression are associated with higher HDL-C levels, whereas higher HDL-C levels do not appear to protect against cognitive decline or depressive symptoms. These findings underscore the importance of preserving cognitive and mental health, which may lower the likelihood of cardiovascular disease and dementia. Future studies should validate these findings and develop targeted interventions tailored to specific populations.

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