Centre for Public Health, Queen's University Belfast, Belfast, UK.
J Alzheimers Dis. 2010;20(3):925-33. doi: 10.3233/JAD-2010-091570.
Evidence accumulating from biological and epidemiological studies suggests that high levels of serum cholesterol may promote the pathological processes that lead to Alzheimer's disease (AD). Lowering cholesterol in experimental animal models slows the expression of Alzheimer's pathology. These findings raise the possibility that treating humans with cholesterol lowering medications might reduce the risk of developing AD or help treat it. The statins (lovastatin, pravastatin, simvastatin, and others) are powerful cholesterol lowering agents of proven benefit in vascular disease. Several clinical studies comparing the occurrence of AD between users and non-users of statins suggested that risk of AD was substantially reduced among the users. However, because these studies were not randomized trials, they provided insufficient evidence to recommend statin therapy. Cochrane reviews are based on the best available information about healthcare interventions and they focus primarily on randomized controlled trials (RCTs). On the issue of prevention, two randomized trials have been carried out and neither showed any reduction in occurrence of AD in patients treated with statins compared to those given placebo. Statins cannot therefore be recommended for the prevention of AD. Regarding treatment of AD, the large RCTs which have assessed this outcome have not published their results. Initial analysis from the studies available indicate statins have no benefit on the outcome measure ADAS-Cog but have a significant beneficial effect on MMSE as an outcome. We need to await full results from the RCTs before we can be certain. In addition statins were not detrimental to cognition in either systematic review.
越来越多的生物学和流行病学研究证据表明，高水平的血清胆固醇可能会促进导致阿尔茨海默病（AD）的病理过程。在实验动物模型中降低胆固醇可以减缓阿尔茨海默病病理的表达。这些发现提出了这样一种可能性，即使用降低胆固醇的药物治疗人类可能会降低患 AD 的风险或有助于治疗 AD。他汀类药物（洛伐他汀、普伐他汀、辛伐他汀等）是一种强大的降胆固醇药物，已被证明对血管疾病有益。几项比较他汀类药物使用者和非使用者 AD 发生情况的临床研究表明，使用者的 AD 风险显著降低。然而，由于这些研究不是随机试验，因此提供的证据不足以推荐他汀类药物治疗。Cochrane 综述基于有关医疗保健干预措施的最佳可用信息，主要侧重于随机对照试验（RCT）。关于预防问题，已经进行了两项随机试验，与安慰剂组相比，他汀类药物治疗组的 AD 发生率均无降低。因此，不能推荐他汀类药物预防 AD。关于 AD 的治疗，评估该结局的大型 RCT 尚未公布其结果。现有研究的初步分析表明，他汀类药物对 ADAS-Cog 这一测量指标没有益处，但对 MMSE 有显著的有益影响。我们需要等待 RCT 的完整结果才能确定。此外，在这两项系统评价中，他汀类药物对认知功能均无损害。
