Benefits and Harms of Statins in People with Dementia: A Systematic Review and Meta‐Analysis

Abstract

OBJECTIVES More people with dementia also fall into the category of high vascular risk, for which a statin is usually prescribed. However, these recommendations are based on studies in people without dementia. We aimed to evaluate the evidence for the long‐term effectiveness and harm of statin therapy in patients with dementia. DESIGN Systematic review of randomized controlled trials and observational research. SETTING Publications from developed countries indexed in the PubMed, Web of Science, and Cochrane trial database between 2007 and 2019. PARTICIPANTS Trials including people with all types of dementia with a mean age older than 65 years. INTERVENTION Treatment with a statin for 6 months or longer. MEASUREMENTS Major adverse cardiovascular events, dementia progression, and general health at 2 years, or medication adverse events (AEs) at any time. Each article was assessed for bias using the Newcastle‐Ottawa or Cochrane Collaboration tools. A narrative synthesis and pooled analyses are reported. RESULTS Five articles met the inclusion criteria. They reported only on dementia of the Alzheimer's type. There was no evidence regarding cardiovascular events or general health. We made a very low confidence finding that statins reduce dementia progression based on three cohort studies of heterogeneous design. We made a very low confidence finding of no significant difference in AEs based on two randomized controlled trials of 18 months: odds ratios of any AE = 1.21 (95% confidence interval [CI] = .83‐1.77), serious AE = 1.03 (95% CI = .76‐1.87), and death = 1.69 (95% CI = .79‐3.62). CONCLUSION Evidence was insufficient to fully evaluate the efficacy of statins in people with dementia. We found that statins may have a small benefit delaying progression in Alzheimer's dementia, although this conflicted with previous findings from shorter randomized trials. For safety, the trial data lacked power to show clinically important differences between the groups. We recommend that clinical data be leveraged for further observational studies to inform prescribing decisions. J Am Geriatr Soc 68:650–658, 2020

Copper, Iron, Selenium and Lipo-Glycemic Dysmetabolism in Alzheimer’s Disease

“…Much research on ApoE in the CNS has focused on its critical role in shuttling cholesterol to neurons for the maintenance of cell membranes and synapses, and for their repair after injury [103]. However, statins appeared to have only a minor benefit, if any, in delaying AD progression [104].…”

“…In addition, since the cognitive decline in AD seems to be driven also by a glycemic dysregulation in addition to a disturbed metal homeostasis, a monotherapy with metal chelation alone is not expected to reverse completely the pathological process. [104] and clioquinol (B) [108]. Dotted lines indicate functional groups responsible for metal chelation.…”

Statins for secondary prevention and major adverse events after coronary artery bypass grafting

“…11,12 It has been suggested that statins might also be beneficial in preventing dementia. 13,14 However, no previous studies have investigated the association between statin use and dementia among post-CABG patients.…”

Statin use in dementia—Review and comparison of guideline recommendations

“…Furthermore, a recent review by Davis et al 9 found no study evaluating efficacy of statins in people with dementia and only few studies evaluating potential adverse events. Therefore, future research is urgently needed to better understand the benefits and risks of statins regarding the prevention of CV events in people with dementia.…”