EP172: Cholesterol Statins and Brain Function

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Dr. Warrick is a practicing cardiologist and author dedicated to educating patients about heart health. In this episode, he addresses two common patient questions: how low cholesterol can go without affecting brain function, and whether statins impair cognitive function. Through examination of clinical trials and natural examples, Dr. Warrick provides evidence-based reassurance about the safety of aggressive cholesterol lowering and statin use for brain health. Key Takeaways: The Ebbinghaus study demonstrated that very low LDL cholesterol levels achieved with PCSK9 inhibitors produced no measurable cognitive impairment, even at levels lower than typically seen after heart attack treatment. Newborn babies naturally have very low LDL cholesterol levels (50-70 mg/dL) during their most active period of brain development, suggesting the brain functions well at these low levels. Families with non-functioning PCSK9 genes maintain very low cholesterol throughout their lives and show no brain dysfunction or cognitive abnormalities, often living long healthy lives. The PROSPER study of nearly 6,000 elderly patients found no difference in cognitive decline between those taking pravastatin and control groups over 3.5 years. The Heart Protection Study using simvastatin and the Jupiter trial using rosuvastatin both found no difference in cognitive outcomes between statin users and non-users across thousands of patients. Of 12 small trials specifically examining statins and cognition, nine showed no difference, one suggested decline, and two suggested cognitive benefit. Some statins are lipophilic (fat-soluble) and may accumulate in brain tissue, while others like rosuvastatin are hydrophilic (water-soluble) and less likely to affect the brain. Individual responses to statins vary, and mental fog may result from multiple lifestyle factors; if cognitive concerns arise, switching to less brain-penetrating statin options is a reasonable approach.