Cognitive Function Assessment in Patients on Moderate- or High-Intensity Statin Therapy

Abstract

Background: Cardiovascular diseases are the leading cause of death in the USA. Statin therapy reduces cardiovascular events significantly. Cognitive impairment has been reported with statin therapy but there is a lack of consensus. We analyzed the cognitive functions of adult patients who were on moderate-intensity statin therapy (MIST) or high-intensity statin therapy (HIST). Methods:A total of 213 patients underwent cognitive assessment testing. Cognitive function scores were correlated with the durations of statin therapy, age, and level of education by using Pearson correlation. Independent t-test was used to compare the mean cognitive function score to the gender, race, type of statin therapy, and comorbid conditions.Results: Mean age of all the patients was 55.4 years. Majority of the patients (66.2%) were on MIST while the rest (33.8%) were on HIST. Cognitive impairment was observed in 17.8% of the studied patients. A total of 41.7% of the patients in the HIST group and 5.7% in the MIST group had cognitive impairment (P < 0.001). There was no correlation between cognitive function score and age (r = -0.106), weakly positive correlation between the level of education and cognitive function score (r = 0.252), and weakly negative correlation between the duration of statin therapy and cognitive function score (r = -0.283). In the group of patients on HIST with cognitive impairment, the proportion of patients on atorvastatin 40 -80 mg was significantly higher than the proportion of patients on rosuvastatin 20 -40 mg (66.7% vs. 33.3%; P < 0.05). In the group of patients on MIST with cognitive impairment, atorvastatin 10 -20 mg was the most commonly used statin therapy (50%), followed by rosuvastatin 10 mg (25%), simvastatin 20 -40 mg (12.5%) and pravastatin 40 -80 mg (12.5%). Conclusions:We found a significantly higher association of cognitive impairment in patients who were on MIST or HIST compared to the general population. We found no correlation between cognitive function score and age, weakly positive correlation between the level of education and cognitive function score, and weakly negative correlation between the duration of statin therapy and cognitive function score. HIST was associated with a higher frequency of cognitive impairment compared to the MIST.

Prehospital Care of Coronary Artery Disease and Its Major Risk Factors in Geropsychiatric Inpatients

“…The only caveat is emerging from work implicating lower cholesterol level in decreasing central serotonergic neurotransmission with effect on cognitive performance, mood, and impulsive behavior, which may influence the clinical course of the psychiatric condition present in our sample. 19 The effect seems to be more prominent in patients treated with the lipophilic statins atorvastatin and simvastatin. 20 A similar framework may also seem reasonable regarding the observed better control of diabetes in our dementia sample.…”

Statins and cognition: Modifying factors and possible underlying mechanisms

“…The association frequency of T2D was significantly higher in the patients on High-Intensity Statin Therapy (HIST) with cognitive impairment in comparison with patients without cognitive impairment. There was no difference in the frequency 10.3389/fnagi.2022.968039 of association of T2D in the patients on Moderate-Intensity Statin Therapy (MIST) with or without cognitive impairment (Roy et al, 2020). Nevertheless, it has been suggested that the benefits of statin use in the prevention and treatment of CVD outweigh the possible adverse effects of statins on cognitive aging associated with T2D (Offer et al, 2019).…”

“…A randomized controlled trial on older adults with hypertension showed that long-term use of 10 mg rosuvastatin may reduce WMH progression and cognitive impairment (Zhang et al, 2019). * Harmful HIST (atorvastatin 40-80 mg, rosuvastatin 20-40 mg) was associated with a higher frequency of cognitive impairment compared to MIST (atorvastatin 10-20 mg, rosuvastatin 10 mg, simvastatin 20-40 mg, and pravastatin 40-80 mg) (Roy et al, 2020).…”

“…However, no significant association was found in the age subgroup of 86 and older, which could be explained by the lower sample size in this subgroup ( Kim et al, 2020 ). Yet, a recent study has found that the association between statin therapy and cognitive function is not modified by age ( Roy et al, 2020 ). Likely, in a nationwide population-based cohort study, statin use was associated with a lower risk of dementia, but no meaningful effect for the relationship between statin use and the risk of dementia was found for age ( Pan et al, 2018 ).…”

Importance of Coagulation Factors as Critical Components of Premature Cardiovascular Disease in Familial Hypercholesterolemia

“…It is therefore highly questionable to use cholesterol-lowering as treatment of people or patients with FH, also because it is well-known that statin treatment has many serious side effects [ 57 ]. The commonest one is considered to be muscular damage, but it is little known that many types of cerebrospinal dysfunction may occur as well, both in mice [ 58 ] and human beings [ 57 , 59 , 60 , 61 ]. They include cognitive dysfunction, suicidal or violent behavior, memory loss, Alzheimer’s, aphasia, polyneuropathy, and many others.…”