Rea Thomas D, Breitner John C, Psaty Bruce M, Fitzpatrick Annette L, Lopez Oscar L, Newman Anne B, Hazzard William R, Zandi Peter P, Burke Gregory L, Lyketsos Constantine G, Bernick Charles, Kuller Lewis H
Department of Medicine, University of Washington, Seattle 98101, USA.
Arch Neurol. 2005 Jul;62(7):1047-51. doi: 10.1001/archneur.62.7.1047.
Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) reduce cardiovascular risk through mechanisms that might affect the development of dementia.
To evaluate whether statin use is associated with a lower risk of dementia compared with never use of lipid-lowering agents (LLAs).
Cohort study of community-dwelling adults 65 years and older. The analysis included 2798 participants free of dementia at baseline.
Using Cox proportional hazards regression analysis, we estimated the risk of incident all-cause and type-specific dementia associated with time-dependent statin therapy compared with never use of LLAs. The primary analyses incorporated a 1-year lag between exposure and outcome. Secondary analyses included the final year of exposure and modeled statin use as current use vs nonuse to simulate a case-control approach.
Compared with never use of LLAs, ever use of statins was not associated with the risk of all-cause dementia (multivariable-adjusted hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.77-1.52), Alzheimer disease alone (HR, 1.21; 95% CI, 0.76-1.91), mixed Alzheimer disease and vascular dementia (HR, 0.87; 95% CI, 0.44-1.72), or vascular dementia alone (HR, 1.36; 95% CI, 0.61-3.06). In contrast, in secondary analyses, current use of statins compared with nonuse of LLAs was associated with HRs of 0.69 (95% CI, 0.46-1.02) for all-cause dementia and 0.56 (95% CI, 0.35-0.92) for any Alzheimer disease.
In this cohort study, statin therapy was not associated with a decreased risk of dementia. Methodological differences may explain why results of this cohort investigation differ from those of prior case-control studies. Additional investigation is needed to determine whether and for whom statin use may affect dementia risk.
他汀类药物（3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂）通过可能影响痴呆症发生发展的机制降低心血管疾病风险。
评估与从未使用降脂药物（LLA）相比，使用他汀类药物是否与较低的痴呆症风险相关。
对65岁及以上社区居住成年人进行队列研究。分析纳入了2798名基线时无痴呆症的参与者。
使用Cox比例风险回归分析，我们估计了与从未使用LLA相比，时间依赖性他汀类药物治疗相关的全因性和特定类型痴呆症的发病风险。主要分析纳入了暴露与结局之间1年的滞后时间。次要分析包括暴露的最后一年，并将他汀类药物使用建模为当前使用与未使用，以模拟病例对照方法。
与从未使用LLA相比，曾经使用他汀类药物与全因性痴呆症风险无关（多变量调整风险比[HR]，1.08；95%置信区间[CI]，0.77-1.52），单独的阿尔茨海默病（HR，1.21；95%CI，0.76-1.91），阿尔茨海默病与血管性痴呆混合（HR，0.87；95%CI，0.44-1.72），或单独的血管性痴呆（HR，1.36；95%CI，0.61-3.06）。相比之下，在次要分析中，与未使用LLA相比，当前使用他汀类药物与全因性痴呆症的HR为0.69（95%CI，0.46-1.02），与任何阿尔茨海默病的HR为0.56（95%CI，0.35-0.92）。
在这项队列研究中，他汀类药物治疗与痴呆症风险降低无关。方法学差异可能解释了为什么这项队列研究的结果与先前病例对照研究的结果不同。需要进一步研究以确定他汀类药物使用是否以及对哪些人可能影响痴呆症风险。
