Statins for dementia

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Statins certainly seem to lower the risk of Alzheimer's. On the other hand, they can sometimes cause temporary memory loss, which does go away if one stops the statins. Find out what you need to know to strike the right balance. 

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As with any medication, the more you know about statins, the more ability you have to help your doctor give you the best treatment possible.

New York times

THE GOOD:
High dose statins prevent dementia 

High doses of statins prevent dementia in older people, according to research presented at the ESC Congress by Dr. Tin-Tse Lin from Taiwan. The study of nearly 58,000 patients found that high potency statins had the strongest protective effects against dementia.

Dr. Lin said: “Statins are widely used in the older population to reduce the risk of cardiovascular disease. But recent reports of statin-associated cognitive impairment have led the US Food and Drug Administration (FDA) to list statin-induced cognitive changes, especially for the older population, in its safety communications.”

He added: “Previous studies had considered statin therapy to exert a beneficial effect on dementia. But few large-scale studies have focused on the impact of statins on new-onset, non-vascular dementia in the geriatric population.”

Accordingly, the current study examined whether statin use was associated with new diagnoses of dementia. The researchers used a random sample of 1 million patients covered by Taiwan’s National Health Insurance. From this they identified 57,669 patients aged >65 years who had no history of dementia in 1997 and 1998. The analysis included pre-senile and senile dementia but excluded vascular dementia.

There were 5,516 new diagnoses of dementia during approximately 4.5 years of follow-up. The remaining 52,153 patients aged >65 formed the control group. Subjects were divided into tertiles according to their mean daily equivalent1 dosage and total (across the entire follow up period) equivalent dosage.

The adjusted hazard ratios (HRs) for dementia were significantly inversely associated with increased daily or total equivalent statin dosage. The HRs for the three tertiles of mean equivalent daily dosage (lowest to highest) were 0.622, 0.697 and 0.419 vs control (p<0 .001="" 0.332="" 0.632="" 0.773="" age="" and="" cardiovascular="" control="" different="" dosage="" effect="" equivalent="" for="" gender="" highest="" hrs="" in="" lowest="" of="" p="" protective="" remained="" risk="" span="" statins="" subgroups.="" tertiles="" the="" three="" to="" total="" trend="" vs="" were="">

THE BAD:
Statin-Associated Memory Loss

Doctors found that some patients to whom they precribed statins ended up reporting memory loss assoicated with the drug. 

It certainly did not happen to everyone. In the study, "Statin-associated memory loss: analysis of 60 case reports and review of the literature", patients reporting such memory loss were identified and observed. Other studies followed, including one in 2010 that reported 600 such cases linked to Lipitor.

Although there was a clear association, no one has been able to prove a cause-and-effect relationship. That is why doctors are careful to check for other reasons behind memory loss before they start cutting back the statins. Heart disease, age and even Alzheimer's can be to blame.

Dementia-expert Dr. P. Murali Doraiswamy offers the following advice.

"Clearly, if lowering the dose made the problem better, then that suggests the statin was the cause. However, reducing the dose of a statin can raise risk for heart disease and stroke in some situations. I don’t recommend people stop or change dose of statins on their own, but to work through their doctors. This may also sometimes involve educating your doctors about the new risks associated with statins."

Dr. Lin said: “The adjusted risks for dementia were significantly inversely associated with increased total or daily equivalent statin dosage. Patients who received the highest total equivalent doses of statins had a 3-fold decrease in the risk of developing dementia. Similar results were found with the daily equivalent statin dosage.”

He added: “It was the potency of the statins rather than their solubility (lipophilic or hydrophilic) which was a major determinant in reducing dementia. High potency statins such as atorvastatin and rosuvastatin showed a significant inverse association with developing dementia in a dose-response manner. Higher doses of high potency statins gave the strongest protective effects against dementia.” 

Dr. Lin continued: “The results were consistent when analysing daily doses of different kinds of statins. Almost all the statins (except lovastatin) decreased the risk for new onset dementia when taken at higher daily doses. A high mean daily dosage of lovastatin was positively associated with the development of dementia, possibly because lovastatin is a lipophilic statin while the anti-inflammatory cholesterol lowering effect of lovastatin is not comparable to that of atorvastatin and simvastatin.”

Dr. Lin concluded: “To the best of our knowledge, this was the first large-scale, nation-wide study which examined the effect of different statins on new onset dementia (except vascular dementia) in an elderly population. We found that high doses of statins, particularly high potency statins, prevent dementia.”

The European Society of CardiologyThe European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

MORE INFORMATION:

About ESC CongressThe ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is "The Heart Interacting with Systemic Organs".  ESC Congress takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information: ESC Congress.

References
More information on the ESC Press Conference page: Statins for all forever?