Zandi Peter P, Sparks D Larry, Khachaturian Ara S, Tschanz Joann, Norton Maria, Steinberg Martin, Welsh-Bohmer Kathleen A, Breitner John C S
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Arch Gen Psychiatry. 2005 Feb;62(2):217-24. doi: 10.1001/archpsyc.62.2.217.
Prior reports suggest reduced occurrence of dementia and Alzheimer disease (AD) in statin users, but, to our knowledge, no prospective studies relate statin use and dementia incidence.
To examine the association of statin use with both prevalence and incidence of dementia and AD.
Cross-sectional studies of prevalence and incidence and a prospective study of incidence of dementia and AD among 5092 elderly residents (aged 65 years or older) of a single county. Participants were assessed at home in 1995-1997 and again in 1998-2000. A detailed visual inventory of medicines, including statins and other lipid-lowering agents, was collected at both assessments.
Diagnosis of dementia and of AD.
From 4895 participants with data sufficient to determine cognitive status, we identified 355 cases of prevalent dementia (200 with AD) at initial assessment. Statin use was inversely associated with prevalence of dementia (adjusted odds ratio, 0.44; 95% confidence interval, 0.17-0.94). Three years later, we identified 185 cases of incident dementia (104 with AD) among 3308 survivors at risk. Statin use at baseline did not predict incidence of dementia or AD (adjusted hazard ratio for dementia, 1.19; 95% confidence interval, 0.53-2.34; adjusted hazard ratio for AD, 1.19; 95% confidence interval, 0.35-2.96), nor did statin use at follow-up (adjusted odds ratio for dementia, 1.04; 95% confidence interval, 0.56-1.81; adjusted odds ratio for AD, 0.85; 95% confidence interval, 0.32-1.88).
Although statin use might be less frequent in those with prevalent dementia, we found no association between statin use and subsequent onset of dementia or AD. Further research is warranted before costly dementia prevention trials with statins are undertaken.
先前的报告表明他汀类药物使用者患痴呆症和阿尔茨海默病（AD）的几率降低，但据我们所知，尚无前瞻性研究探讨他汀类药物的使用与痴呆症发病率之间的关系。
研究他汀类药物的使用与痴呆症及AD的患病率和发病率之间的关联。
对一个县的5092名老年居民（年龄在65岁及以上）进行痴呆症及AD患病率和发病率的横断面研究以及发病率的前瞻性研究。在1995 - 1997年和1998 - 2000年对参与者进行了两次家访评估。在两次评估中均收集了详细的药物清单，包括他汀类药物和其他降脂药物。
痴呆症和AD的诊断。
在4895名有足够数据确定认知状态的参与者中，我们在初次评估时确定了355例痴呆症患者（200例为AD）。他汀类药物的使用与痴呆症患病率呈负相关（调整后的优势比为0.44；95%置信区间为0.17 - 0.94）。三年后，在3308名有风险的幸存者中，我们确定了185例新发痴呆症患者（104例为AD）。基线时使用他汀类药物并不能预测痴呆症或AD的发病率（痴呆症的调整后风险比为1.19；95%置信区间为0.53 - 2.34；AD的调整后风险比为1.19；95%置信区间为0.35 - 2.96），随访时使用他汀类药物也不能预测（痴呆症的调整后优势比为1.04；95%置信区间为0.56 - 1.81；AD的调整后优势比为0.85；95%置信区间为0.32 - 1.88）。
尽管痴呆症患者使用他汀类药物的频率可能较低，但我们发现他汀类药物的使用与随后发生的痴呆症或AD之间没有关联。在进行昂贵的他汀类药物预防痴呆症试验之前，有必要进行进一步研究。
