Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
Atherosclerosis. 2013 Oct;230(2):171-6. doi: 10.1016/j.atherosclerosis.2013.07.009. Epub 2013 Jul 26.
Dementia is a major public health problem because of its high prevalence in elderly individuals, particularly in the growing category of subjects aged 80 years or more. There is accumulating evidence that cholesterol may be implicated in the pathogenesis of dementia, and this has led us to assess the relationship between time spent with statins available and the risk of hospitalization for dementia.
A population-based, nested case-control study was carried out by including the cohort of 152,729 patients from Lombardy (Italy) aged 40 years or older who were newly treated with statins between 2003 and 2004. Cases were the 1380 patients who experienced hospitalization for dementia disease from initial prescription until 2010. Up to twenty controls were randomly selected for each case. Logistic regression was used to model the risk of dementia associated with the cumulative time during which statins were available. Monte-Carlo and rule-out sensitivity analyses were performed to account for unmeasured confounders.
Compared with patients who had very short statins coverage (less than 6 months), those on 7-24, 25-48, and >48 months of coverage respectively had risk reductions of 15% (OR: 0.85; 95% CI: 0.74 to 0.98), 28% (OR: 0.72; 95% CI: 0.61 to 0.85), and 25% (OR: 0.75; 95% CI: 0.61 to 0.94). Simvastatin and atorvastatin were both associated with a reduced risk of dementia, while no similar evidence was observed for fluvastatin and pravastatin.
Long-term use of statins seems effective for the prevention of dementia.
痴呆是一个主要的公共卫生问题，因为它在老年人中发病率很高，尤其是在 80 岁及以上的人群中。越来越多的证据表明胆固醇可能与痴呆的发病机制有关，这促使我们评估可用他汀类药物的使用时间与痴呆住院风险之间的关系。
通过纳入 2003 年至 2004 年期间在伦巴第（意大利）新接受他汀类药物治疗的年龄在 40 岁及以上的 152729 名患者的队列，进行了一项基于人群的巢式病例对照研究。病例为从初始处方到 2010 年期间因痴呆病住院的 1380 名患者。每个病例随机选择 20 名对照。使用逻辑回归模型来模拟与他汀类药物可用的累积时间相关的痴呆风险。进行了蒙特卡罗和排除敏感性分析，以解释未测量的混杂因素。
与他汀类药物覆盖时间非常短（不足 6 个月）的患者相比，覆盖时间分别为 7-24、25-48 和>48 个月的患者的风险降低了 15%（OR：0.85；95%CI：0.74 至 0.98）、28%（OR：0.72；95%CI：0.61 至 0.85）和 25%（OR：0.75；95%CI：0.61 至 0.94）。辛伐他汀和阿托伐他汀均与痴呆风险降低相关，而氟伐他汀和普伐他汀则没有类似证据。
长期使用他汀类药物似乎对预防痴呆有效。
