Statins may facilitate Parkinson's disease: Insight gained from a large, national claims database

Abstract

Objective Using a large US claims database (MarketScan®), we investigated the controversy surrounding the role of statins in Parkinson’s disease (PD). Methods We performed a retrospective case-control analysis. First, we identified 2,322 incident PD cases having a minimum of 2.5 y of continuous enrollment prior to earliest diagnosis code or prescription of antiparkinson medication. Then, 2,322 Controls were matched individually by age, gender, and a “follow-up window” to explore the relationship of statin use with incident PD. Results Statin usage was significantly associated with PD risk, with the strongest associations being for lipophilic (OR=1.58, p<0.0001) vs. hydrophilic (OR=1.19, p=0.25) statins, statins plus non-statins (OR=1.95, p<0.0001), and for the initial period after starting statins (<1 y OR=.82, 1–2.5 y OR =1.75, and ≥2.5 y OR =1.37; ptrend<0.0001). Conclusion Use of statin (especially lipophilics) was associated with higher risk of PD, and the stronger association in initial use suggests a facilitating effect.

Higher serum cholesterol and decreased Parkinson's disease risk: A statin‐free cohort study

“…Although this approach could pave the way to reduce CVD risk, its one‐size‐fits‐all concept overlooks the diversity in the actual benefits of higher serum cholesterol levels. Moreover, most recent studies on the statin–PD relationship that have found statin use may unmask or increase the occurrence of PD support our findings and heighten the importance of tailoring individualized stratifying risk and therapeutic strategies based on personal background.…”

Understanding the Links Between Cardiovascular Disease and Parkinson's Disease

“…The evidence is reasonably robust, including support from multiple prospective cohorts . If future studies show causality, there will be important clinical implications for statin use in PD patients or in individuals at risk for PD …”

“…Statins have been suggested to be neuroprotective for PD, yet a prospective study in the Atherosclerosis Risk in Community cohort found that statin usage was associated with the increased future risk of PD . Recently, an analysis of the large MarketScan national claims database in the United States found that statins were positively associated with a PD diagnosis . Although these data suggest caution to proposing statins as being neuroprotective for PD, they did not deter the launch of a trial of simvastatin as a neuroprotective agent .…”

“…High CV disease risk scores are associated with higher PD motor scores, and worse cognitive performance, but nevertheless PD patients with high CV risk scores are frequently not treated with statins, despite some evidence of their beneficial effects in this subgroup without PD . As alluded to already, there is also evidence that suggest that the use of statins may increase PD risk, suggesting that this important issue should be approached cautiously …”

Statins and Cognition in Parkinson’s Disease

“…A Taiwanese study found that statin therapy continuation, versus discontinuation, was associated with decreased risk of PD, especially in lipophilic SU [9]. However, there are contradictory findings, including statins either raising or having non-significant effects on PD risk [10–12]. …”