Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Geriatr Gerontol Int. 2010 Apr;10(2):199-208. doi: 10.1111/j.1447-0594.2009.00579.x. Epub 2010 Jan 19.
Non-hypolipidemic effects of statins, known as pleiotropic effects, are likely to explain the effect of statins on dementia. Results of the relationship between statins and dementia in previous studies are conflicting. There is no systematic review investigating the effect of statins on vascular dementia (VaD). This systematic review evaluates the role of statins in the prevention of VaD or dementia. The possible causes of conflicting results in the existing published work will be explored.
Relevant studies were systematically identified and reviewed. The Cochrane Controlled Trials and three electronic databases (MEDLINE, EMBASE and PsycInfo) were searched. The selection criteria were defined a priori. Included studies were rated by quality assessment checklists and two independent reviewers.
Six studies in dementia, two studies in VaD (one study reported both dementia and VaD) and two meta-analyses met the selection criteria. The studies covered 1372 cases of dementia from 14 430 participants and 116 cases of VaD from 4924 participants from the USA and UK. There was no association between statin use and risk of VaD. The protective effect of statins on dementia was demonstrated only in a nested case-control study of lower quality and one recently published cohort study. In most other cohort and high quality studies, statin use did not show a beneficial effect.
Study design differences among the studies and methodological shortcomings may have resulted in different outcomes. On the basis of these conflicting results, statins could not be recommended as a preventative treatment for dementia.
他汀类药物的非降脂作用（即多效性作用）可能可以解释他汀类药物对痴呆的作用。先前研究中他汀类药物与痴呆之间的关系结果相互矛盾。目前尚无系统评价研究他汀类药物对血管性痴呆（VaD）的影响。本系统评价评估了他汀类药物预防 VaD 或痴呆的作用。将探讨现有已发表研究结果相互矛盾的可能原因。
系统地检索了相关研究。检索了 Cochrane 对照试验和三个电子数据库（MEDLINE、EMBASE 和 PsycInfo）。事先定义了选择标准。纳入的研究通过质量评估检查表和两位独立审查员进行了评估。
符合选择标准的有 6 项痴呆研究、2 项 VaD 研究（其中 1 项研究同时报告了痴呆和 VaD）和 2 项荟萃分析。这些研究涵盖了来自美国和英国的 14430 名参与者中的 1372 例痴呆病例和 4924 名参与者中的 116 例 VaD 病例。他汀类药物的使用与 VaD 的风险之间没有关联。他汀类药物对痴呆的保护作用仅在一项质量较低的嵌套病例对照研究和一项最近发表的队列研究中得到了证明。在大多数其他队列和高质量研究中，他汀类药物的使用并没有显示出有益的效果。
研究设计的差异和方法学上的缺陷可能导致了不同的结果。基于这些相互矛盾的结果，不能推荐他汀类药物作为痴呆的预防治疗。
