Statin therapy not associated with dementia, cognitive impairment in older patients
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Statin therapy was not associated with dementia, mild cognitive impairment and/or any of its subclassifications, according to a secondary analysis of the ASPREE trial of aspirin therapy among older adults.
However, researchers found impaired cognitive ability at baseline was an effect modifier for dementia and episodic memory among older adults on statin therapy.
As Healio previously reported, in the main findings from the ASPREE randomized trial, aspirin for the primary prevention of CVD was not beneficial among older adults and conferred an increase in risk for major hemorrhage.
For this analysis of the ASPREE cohort, published in the Journal of the American College of Cardiology, researchers assessed 18,846 participants (median age, 74 years; 56% women; 31% on statins at baseline) who had no history of CV events, major physical disability or dementia and were followed for 4.7 years. The participants were stratified by whether or not they used a statin at baseline.
“Compared with no statin use, baseline statin use was not associated with incident dementia or MCI and their subclassifications; nor was statin use associated with changes over time in composite cognition and its components, including global cognition, episodic memory, language and executive function, and psychomotor speed,” Zhen Zhou, PhD, postdoctoral research fellow at the Menzies Institute for Medical Research at the University of Tasmania in Hobart, Australia, and colleagues wrote. “These results did not differ by statin lipophilicity. However, the associations of statin use with dementia outcomes and memory change differed among participants with different composite cognitive levels at baseline, with the outcome risks for statin use increasing as baseline cognitive levels decreased.”
Outcomes of interest included incident dementia and its subclassifications; mild cognitive impairment and its subclassifications; and changes in domain-specific cognition, including global cognition, memory, language and executive function, psychomotor speed and the composite of these presentations.
Statin therapy and cognitive health
According to the study, statin use was not associated with risk for all-cause dementia (HR = 1.16; 95% CI, 0.97-1.4; P = .11), probable Alzheimer’s disease (HR = 1.33; 95% CI, 1-1.77; P = .05) or mixed presentations of dementia (HR = 1.06; 95% CI, 0.82-1.35; P = .67) compared with nonuse among older adults.
Researchers reported that statin use was also not associated with risk for mild cognitive impairment (HR =0.97; 95% CI, 0.77-1.22; P = .81), mild cognitive impairment consistent with Alzheimer’s disease (HR = 1.44; 95% CI, 0.9-2.29; P = .13) or other mild cognitive impairments (HR = 0.86; 95% CI, 0.66-1.12; P = .26).
In addition, researchers observed no difference in the change of composite cognition and any individual cognitive domains between the statin use and nonuse groups (P for all > .01) and no differences in any of outcome of interest between users of hydrophilic or lipophilic statins.
However, researchers did find interaction effects between baseline composite cognition and statin therapy for all dementia outcomes (P for interaction for all < .05) and change in episodic memory (P for interaction = .02).
Statin use in practice
“On the basis of accumulated evidence, lipid lowering in the short term does not appear to result in improvement or deterioration of cognition irrespective of baseline LDL levels and medication used,” Christie M. Ballantyne, MD, professor and chief of cardiology, and Vijay Nambi, MD, PhD, associate professor at Baylor College of Medicine, wrote in a related editorial. “The present study further provides additional information that the lipo- or hydrophilicity of the statin does not affect changes in cognition. However, the potential increased risk for Alzheimer’s disease, especially among patients with baseline cognitive impairment, requires further investigation.”
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