Impact of Statin Use on Dementia Incidence in Elderly Men and Women with Ischemic Heart Disease

Abstract

This study aimed to determine the association between statins and the prevention of dementia according to sex differences in elderly patients with ischemic heart disease (IHD). We performed a nationwide retrospective cohort study using the Korean Health Insurance Review and Assessment Service database (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Among the 264,036 eligible patients aged ≥65 years with IHD, statin users were compared with non-users by propensity score matching at a 1:1 ratio (71,587 in each group). The primary outcome was dementia risk by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Differential risks of dementia were assessed by sex in the subgroups of statin types, exposure duration, and patient age, implying that sex is an influential factor for the link between statin use and dementia incidence. Among seven commonly prescribed statins, rosuvastatin was associated with the greatest preventive effect on dementia incidence, with an adjusted HR of 0.82 (95% CI = 0.78-0.87). In a subgroup analysis organized by sex, the differential risk of dementia incidence was assessed in each statin group, implying that sex is an influential factor for the link between statin and dementia. This study suggests that appropriate statin use considering sex differences may have beneficial effects on the development of dementia.

Early metabolic impairment as a contributor to neurodegenerative disease: Mechanisms and potential pharmacological intervention

“…More specifically, in mouse models of AD, the use of statin lowered hippocampal Aβ levels and improved cognitive awareness (82). Clinically, studies have reported that the use of statin is associated with lower risk of dementia in elderly populations (83). In animal models of PD, statins attenuated dopamine depletion, enhanced BDNF production, and decreased neuroinflammatory markers such as TNFα and Il‐1β.…”

Statins and cognition: Modifying factors and possible underlying mechanisms

“…In the age subgroup of 75-85, atorvastatin and rosuvastatin use was associated with reduced AD risk. However, no significant association was found in the age subgroup of 86 and older, which could be explained by the lower sample size in this subgroup (Kim et al, 2020). Yet, a recent study has found that the association between statin therapy and cognitive function is not modified by age (Roy et al, 2020).…”

“…Major reduction in the dementia risk (Poly et al, 2020). Reduction of dementia risk only in men with IHD (Kim et al, 2020). Preclinical meta-analysis showed the maximum reduction of Aβ plaques (Rahman et al, 2020).…”

Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease

“…Statins, which are used to treat hyperlipidemia, may delay progression to AD 96 ; rosuvastatin was associated with a decreased risk of dementia among patients with ischemic heart disease. 97 However, it has also been suggested that statins may be associated with dementia; so, further research is needed. 98 Observational data for blood pressure control suggest that the window of highest benefit for the treatment of hypertension is in midlife, and that overaggressive control of hypertension in the elderly is associated with cognitive decline and dementia, possibly due to hypoperfusion from hypotension.…”