Statins may lower risk for any dementia among adults with heart failure
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Key takeaways:
- People with heart failure taking statins were less likely to develop any form of dementia.
- Statin use was also associated with a reduction in all-cause mortality risk.
Researchers reported that a population-based study shows statin use among older adults with heart failure was associated with a 20% lower risk for all-cause dementia, including a 28% reduction in risk for developing Alzheimer’s disease.
The results, which also demonstrated an 18% reduction in risk for vascular dementia, remained consistent across subgroups, including age, sex, comorbidities and education levels, indicating that the cognitive benefits of statin may extend to a broad population of people with HF, according to Kai-Hang Yiu, MBBS, MD, PhD, MRCP, assistant hospital chief executive of the University of Hong Kong Shenzhen Hospital, China, and colleagues.
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“Given HF’s strong association with cognitive impairment and its assorted complications, potential strategies to reduce the risk of dementia in patients with HF are urgently needed,” Yiu and colleagues wrote in The Lancet Regional Health – Western Pacific. “Accordingly, emerging evidence has suggested that higher LDL concentrations were associated with an increased dementia risk independent of vascular risk factors.”
Yiu and colleagues analyzed data from 104,295 adults with a diagnosis of HF from 2004 to 2018, using the Hong Kong Clinical Data Analysis and Reporting System database. The mean age of patients was 74 years; 50.3% were men. Researchers estimated the risks for all-cause dementia and its subtypes among adults prescribed statin therapy (n = 54,004) and those not prescribed statins (n = 50,291). The primary outcome was incident dementia, including subtypes of Alzheimer’s disease, vascular dementia and unspecified dementia subsequent to HF diagnosis. The secondary outcome was all-cause mortality.
During a median of 9.9 years of follow-up, 9.6% of patients were diagnosed with dementia. Among those, 2,250 had Alzheimer’s disease; 1,831 had vascular dementia and 5,950 had unspecified dementia. The 10-year cumulative incidence of overall dementia was 11% among statin nonusers and 7.3% among statin users.
After applying inverse probability of treatment weighting, researchers found that statin use was associated with a 20% lower risk for incident dementia compared with nonuse, with an adjusted subdistribution HR (aSHR) of 0.8 (95% CI, 0.76-0.84).
In analyses stratified by dementia subtype, statin use was associated with a 28% lower risk for Alzheimer’s disease (aSHR = 0.72; 95% CI, 0.63-0.82), an 18% lower risk for vascular dementia (aSHR = 0.82; 95% CI, 0.7-0.95) and a 20% lower risk for unspecified dementia (aSHR = 0.8; 95% CI, 0.75-0.85).
Among the cohort, 60.4% died during follow-up. Statin use was associated with a 30% lower risk for all-cause mortality (HR = 0.7; 95% CI, 0.69-0.72).
“These findings provided compelling evidence suggesting that statins may employ additional cognitive protective mechanisms, beyond their lipid-lowering effects, in reducing the risk of dementia,” the researchers wrote. “Possible mechanisms contributing to this protective effect may include but are not limited to anti-inflammatory effects, antioxidant properties and modulation of amyloid-beta metabolism.”
The researchers noted that the findings could reflect “prescription bias,” with patients with HF who were prescribed statins differing from those who do not receive such treatment. Additionally, information on left ventricular ejection fraction was unavailable and researchers were unable to determine the precise dosage of statin therapy for each patient.
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