Some patients are reluctant to use, or refuse to use, statins due to mass and social media statements and rumors about possible adverse effects on cognitive function, particularly in older patients. There were some early case reports that reported associations between statin use and reduced cognition. In addition, the US Food and Drug Administration warned about these possible adverse effects in 2012. These concerns can reduce patient adherence to statin use which is of high importance in primary and secondary prevention of cardiovascular disease. Results from trials and observational studies have been inconsistent.
Therefore, a recent systematic review and meta-analysis addressing the relationship of statin use and risk of dementia or Alzheimer’s disease based on observational studies is very important (1). This paper was published in on 6 December 2021 in the European Journal of Preventive Cardiology. In total, a pooled analysis of 36 studies found that statins were associated with a decreased risk of dementia (OR 0.80 (CI 0.75-0.86). For Alzheimer’s disease, the association with statins based on 21 studies, was also reduced (OR 0.68 (CI 0.56-0.81). There was no sex difference in the risk reduction, the results were similar for lipophilic and hydrophilic statins, and stronger for high-potency statins compared to low-potency statins.
The authors conclude that the results confirm the absence of a neurocognitive risk related to treatment with statins. In addition, the authors conclude that this study supports the recommendation of using stains in both primary and secondary prevention of cardiovascular disease even in older subjects, as there were many older subjects enrolled in the studies that were included in the analyses. Cognitive considerations should not play a role in decision making for most patients when statins are indicated. Finally, although the authors suggest that there might be a favorable role for statins when it comes to prevention of dementia, they discuss the risk of bias in the observational studies, and they do not state that this should be a recommendation. Randomised clinical trials of high quality are warranted to study a possible protective effect of statins on the risk of dementia.
It is important for health workers to be aware of this paper in order to be able to discuss the lack of an association between statin use and decline in cognitive function, hopefully resulting in increased adherence in patients who are reluctant and where this medication is prescribed.