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Diabetes, Cardio-Metabolic Newsletter
Sleep Apnea- DM
4/7/2014
Elderly patients who received the highest total equivalent doses of high-potency statins, such as
atorvastatin or rosuvastatin, had a threefold decrease in the risk of developing dementia, according
to a retrospective, observational study in Taiwan.Dr. Tin-Tse Lin, who presented the study at the annual
congress of the European Society of Cardiology, said that the mechanism might be due to the statins’ effect
on cholesterol reduction, antithrombotic activity, and their anti-inflammatory effect. The study, however,
showed that lesser-prescribed lovastatin at a higher dose was positively associated with dementia
development. The findings add another piece to the statin-dementia puzzle and may alleviate some of the
concerns with the so-called "brain fog" effect of statins, experts said.Dr. Kim Williams Sr., chair of cardiology
at Wayne State University, Detroit, said that the study "was very reassuring in that there was no real evidence
of dementia with the statins that we tend to use, which are the more powerful ones." Older statins like
lovastatin, however, are still of concern, said Dr. Williams, vice president of the American College of
Cardiology, who was not involved in the study. In 2012, the Food and Drug Administration added a warning to
the statins’ label that the drugs could cause temporary memory loss and confusion. Meanwhile, several
studies, including a 2012 review, have found no causality or conclusive relationship between statins and
cognitive impairment.For the Taiwanese study, researchers used a random sample of 1,000,000 people
covered by the country’s National Health Insurance. They identified nearly 58,000 patients who were older
than 65 years of age and without a history of dementia in 1997 and 1998. The patients were followed up for
an average of 4.5 years. The study was divided into tertiles – low, medium, and high dosage – according to
mean daily equivalent or total (across the entire follow-up period) equivalent dosage. The primary endpoint
was new diagnosis of presenile and senile dementia. Patients with vascular dementia were excluded. More
than 5,500 developed dementia. The remaining 52,000 patient served as controls. Results showed that the
adjusted hazard ratios for dementia were significantly inversely associated with increased total or daily
equivalent statin dosage among the tertiles. For total equivalent statin dosage, the hazard ratios for dementia
were 0.77 (low dosage), 0.63 (medium), and 0.33 (high), compared with controls, all significant differences.
For mean equivalent daily dosage, HRs for dementia were 0.62, 0.70, 0.42, respectively, compared with
controls, also significant differences. The authors said that the protective effect of statins remained robust in
different age, gender, and cardiovascular risk subgroups, with strong statistical trends. Dr. Lin of the National
Taiwan University Hospital, Hsin-Chu, Taiwan, said he did not know whether the findings would apply to other
ethnicities. He hypothesized that because disorders of cholesterol metabolism could lead to an increased
incidence of cerebrovascular disease, and elevation of the cholesterol level may result in a high inflammatory
status associated with neurodegeneration, "I think it is reasonable to say that statins may facilitate lowering
the risk of dementia."Prof. Terje R. Pedersen of the University of Oslo (Norway), who commented on the
study, said that "It is implausible that statins have any impact on progression of Alzheimer’s disease, but it
might be plausible to think that when you prevent extensive atherosclerosis, then you also prevent dementia."
The bottom line, said Dr. Williams, is that the study "adds another dimension to the idea that the stronger
statins that are used in the highest doses have the best benefit. That’s certainly true for the cardiovascular
risk and now with dementia prevention."