November 20, 2019
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Statins do not confer memory, cognition decline in older patients

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Katherine Samaras

Statin therapy in elderly patients was not linked to a greater decline in cognition or memory during a 6-year period, according to a study published in the Journal of the American College of Cardiology.

“We could find no adverse effects of statins on memory over 6 years, comprehensively evaluated on four occasions using five different memory tests, nor could we find any detrimental effects on other domains of cognition including the domains of executive function, language, visuospatial function, attention or processing speed, or the composite of global cognition,” Katherine Samaras, MBBS, PhD, professor of medicine at St. Vincent’s Clinical School at University of New South Wales in Kensington, Australia, senior staff specialist in the department of endocrinology at St. Vincent’s Hospital in Darlinghurst, Australia, and laboratory head at Garvan Institute of Medical Research in Darlinghurst, told Healio. “We also found no effect of statins on brain volumes over 2 years, particularly on brain regions involved in memory, specifically the hippocampus and parahippocampus.”

Patients from Australia

Researchers analyzed data from 1,037 patients from the Sydney Memory and Ageing Study aged 70 to 90 years. Psychologists and nurses conducted follow-up every 2 years on four occasions during a 6-year period, during which standardized questionnaires were conducted to collect information on medical conditions, sociodemographic data, medication use and laboratory measures. Brain MRIs were performed in 529 patients, of whom 408 had a repeat MRI at 2 years.

Primary outcome measures were memory and global cognition. The three brain regions of interest were total brain volume, hippocampal volume and parahippocampal volume.

Patients were categorized as statin never users (n = 395; mean age, 79 years; 58% men) or statin ever users (n = 642; mean age, 79 years; 72% men). At baseline, the mean duration of statin use was 9.1 years.

Decline in memory and global cognition was similar over 6 years between patients who continuously used statins and those who never used the therapy. Statin initiation was linked to an attenuation in the rate of memory decline (P = .038).

There were test-wise interactions between statin therapy use and apolipoprotein E epsilon 4 on the decline in long-delayed recall (P = .003), heart disease on the decline in total learning (P = .013) and sex on logical memory decline (P = .013).

Both groups had similar hippocampal volume, parahippocampal volume and total brain volume at baseline with no significant differences over 2 years.

“This study offers reassurance to consumers who hold concerns about harmful statin effects on memory and cognition,” Samaras and colleagues wrote.

“We have an aging population, and memory and cognitive function is a concern for all of us, whether as individuals, family members, a community, doctor, health planners or policymakers,” Samaras said in an interview. “We should be including robust (rather than superficial) measures of cognition in our clinical studies of older people in the domains of cardiology, lipidology, diabetes and metabolism, where dementia risk is increased. This is necessary not only for our understanding as researchers and clinicians, but to inform consumers.”

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Potential implications

Costantino Iadecola, MD, director of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, and Neal S. Parikh, MD, MS, assistant professor of neurology at Weill Cornell Medicine, wrote a related editorial, in which they said: “Taken together, these data support the view that worries about cognitive impairment should not limit statin use and raise the possibility that statins may favorably alter cognitive trajectories in a group of elderly subjects at high risk of Alzheimer’s disease. The latter finding is of great interest and requires additional mechanistic clarification and rigorous clinical validation.” – by Darlene Dobkowski

For more information:

Katherine Samaras, MBBS, PhD, can be reached at k.samaras@garvan.org.au; Twitter: @katesamaras.

Disclosures: Samaras, Iadecola and Parikh report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.