An assessment by the Statin Cognitive Safety Task Force: 2014 update

Rojas‐Fernandez, Carlos; Goldstein, Larry B.; Levey, Aĺlan I.; Taylor, Beth A.; Bittner, Vera

doi:10.1016/j.jacl.2014.02.013

Cited by 96 publications

(62 citation statements)

References 75 publications

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“…Cognitive impairment can therefore be defined as a decline from baseline in any of the 4 domains, sometimes CLINICAL REVIEW overlapping one another. 4 For an overview of some validated tests used to examine cognition, refer to Table 1. [5][6][7][8] In 2013, Richardson et al 9 conducted a systematic review of observational and randomized trials looking at the effects of statins on cognition.…”

Section: Statins and Their Effect On Cognitionmentioning

confidence: 99%

“…4 It recommends cognitive testing, looking at other potential contributors such as anticholinergic medications (e.g., diphenhydramine, tricyclic antidepressants, some antipsychotics) and performing a risk assessment of stopping or decreasing the dose vs continuing the statin. Statins have robust evidence supporting their use in secondary prevention of cardiovascular events.…”

Section: Managing Cognitive Impairment As a Side Effectmentioning

confidence: 99%

“…On the opposite end of the spectrum, some research evaluated the potential use of statins in the prevention and treatment of Alzheimer disease (AD). 4 This article focuses on the effects of statins on cognition and the use of statins for the prevention and treatment of AD. Searches were limited to systematic reviews and meta-analyses only and restricted to English language and humans.…”

Section: Introductionmentioning

confidence: 99%

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Statins and their effect on cognition

Gauthier

Massicotte

2015

Can Pharm J

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IntroductionLipid-lowering drugs, such as statins, rank in the top 5 most frequently used prescription drugs in Canada. In fact, between 2007 and 2011, more than 2.9 million Canadians were taking a lipid-lowering drug. 1 With a plethora of robust evidence for secondary prevention of cardiovascular disease, coupled with a well-tolerated adverse effect profile, it is no wonder that statins are prescribed quite often. In the past decade, however, some case reports have suggested a possible increase in the risk of cognitive adverse events, such as memory loss, forgetfulness or feeling "fuzzy, " associated with their use. 2In 2005, Health Canada released a statement in the Canadian Adverse Reaction Newsletter suggesting a possible association between statins and memory loss. 3 The onset of these adverse events described in the case reports varied, but most occurred within 1 year of statin initiation. Most of the cases (11/19) reported an improvement in cognitive symptoms once the statin was stopped or the dose reduced. In 2012, the Food and Drug Administration (FDA) issued a safety announcement to health care professionals, warning them about the potential risk of cognitive impairment (memory loss, forgetfulness, amnesia, memory impairment, confusion) with the use of statins for a period of 1 day to years.2 Review of these cases did not reveal an association between cognitive impairment and a specific statin, dose or age of patient. These cases were generally reversible, with symptoms disappearing approximately 3 weeks after statin discontinuation. The FDA also enforced a change in the monograph of statin products to warn health care professionals about this rare, but possible, adverse event. This change in monograph has not been mandated in Canada. On the opposite end of the spectrum, some research evaluated the potential use of statins in the prevention and treatment of Alzheimer disease (AD). 4 This article focuses on the effects of statins on cognition and the use of statins for the prevention and treatment of AD. rosuvastatin, fluvastatin, pravastatin, simvastatin, lovastatin, statin*, cogniti*, dement*, and memory. Searches were limited to systematic reviews and meta-analyses only and restricted to English language and humans. A total of 71 potentially relevant articles were identified. After removal of duplicates and irrelevant and older systematic reviews, which contained trials that were analyzed in more recent systematic reviews, a total of 5 articles were considered the best available evidence. Based on the Evidence Updates from BMJ News Alerts, another recently published meta-analysis, which was not identified with our search strategy due to its recent publication, was also examined. Search strategy and findings Statins and their effect on cognitionBroadly speaking, cognition may be subdivided under 4 domains: executive function, memory, language and visuospatial ability. Cognitive impairment can therefore be defined as a decline from baseline in any of the 4 domains, sometimesCLINICAL REVIEW overlappi...

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Section: Statins and Their Effect On Cognitionmentioning

confidence: 99%

Section: Managing Cognitive Impairment As a Side Effectmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Statins and their effect on cognition

Gauthier

Massicotte

2015

Can Pharm J

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“…These data do not allow for appropriate causality assessment. To date, the weight of the evidence (albeit of low to moderate quality) does not support the contention that statins have a clear propensity to meaningfully or commonly contribute to adverse cognitive effects" [22].…”

Section: Central Nervous Systemmentioning

confidence: 99%

Non-traditional Dosing of Statins in Statin-Intolerant Patients—Is It Worth a Try?

Cornier

Eckel

2014

Curr Atheroscler Rep

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In this manuscript, three manifestations of statin intolerance will be covered. The first, myopathy, is mostly subjective with variable complaints of myalgias often worsened by exercise, muscle cramping or weakness, and at times associated with a biomarker, elevations in creatine kinase (CK). A rare but serious manifestation can be rhabdomyolysis. The second, liver toxicity, is associated with reversible biochemical increases in transaminases and rarely other liver function tests. Finally, statin-related central nervous system (CNS) toxicity typically defined as cognitive impairment is quite rare and appears to be idiosyncratic. Statin dose alternatives will then be discussed and highlighted in the setting of the new cholesterol-lowering guidelines. Non-statin lipid-altering therapies as well as other alternative therapies will also be reviewed.

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“…For example, systematic reviews and meta-analyses have not shown consistent evidence of adverse effects of statins on cognition, and the Statin Cognitive Safety Task Force in 2014 concluded that statins are not associated with these adverse effects. 7 Furthermore, a recent study that used eight neuropsychological measures and functional magnetic resonance imaging showed no convincing evidence of memory dysfunction as a result of atorvastatin therapy. 8 Two moderately sized trials of PCSK9 inhibitors for lowering LDL cholesterol level 9,10 and a meta-analysis that included smaller trials 11 showed an association between these drugs and cognitive adverse events reported by the patients.…”

mentioning

confidence: 98%