Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Intern Med. 2015 Mar;277(3):343-352. doi: 10.1111/joim.12262. Epub 2014 May 21.
The objective of this study was to examine the association between the use of statins and the risk of newly diagnosed dementia in an elderly population.
DESIGN, SETTING AND PARTICIPANTS: Random samples of 1,000,000 individuals covered by the National Health Insurance in Taiwan were included in the analysis. All participants were 65 years or older without dementia and either did or did not start treatment with statins from 1 August 1997 to 31 December 2010. Patients with established dementia before the start of treatment were excluded. Baseline characteristics were matched (by propensity score) in those who did and did not receive statins.
A total of 57,669 subjects were included in the analysis with approximately 12 years of follow-up. Propensity score matching identified 2003 patients who received statins and another 2003 patients who did not with comparable baseline characteristics. Adjusted hazard ratios (HRs) for dementia were significantly inversely associated with total or daily equivalent statin dosage (total accumulated dose: HRs 0.829, 0.720 and 0.385 from T1 to T3 vs. control, P < 0.001 for trend; mean daily dose: HRs 0.667, 0.798 and 0.503 from T1 to T3 vs. control, P < 0.001). The results remained robust after propensity adjustment.
Independent of traditional risk factors, there was a decrease in newly diagnosed cases of dementia in elderly patients who had received a high total or daily dose of statins. The more potent statins (e.g. atorvastatin and rosuvastatin) seemed to be particularly effective in the prevention of dementia.
本研究旨在探讨老年人群中使用他汀类药物与新发痴呆风险之间的关系。
设计、地点和参与者：本研究纳入了台湾全民健康保险覆盖的 100 万人的随机样本。所有参与者年龄均在 65 岁及以上，无痴呆症，且在 1997 年 8 月 1 日至 2010 年 12 月 31 日期间，或开始接受他汀类药物治疗，或未开始接受他汀类药物治疗。在开始治疗前已确诊为痴呆的患者被排除在外。在接受或未接受他汀类药物治疗的患者中，通过倾向评分匹配了基线特征。
共纳入了 57669 名患者进行分析，随访时间约为 12 年。倾向评分匹配后，共纳入了 2003 名接受他汀类药物治疗的患者和 2003 名未接受他汀类药物治疗的患者，两组患者的基线特征相似。调整后的痴呆风险比（HRs）与他汀类药物的总剂量或日等效剂量呈显著负相关（总累积剂量：T1 至 T3 组与对照组相比，HRs 分别为 0.829、0.720 和 0.385，P<0.001 呈趋势性；平均日剂量：T1 至 T3 组与对照组相比，HRs 分别为 0.667、0.798 和 0.503，P<0.001）。经倾向评分调整后，结果仍然稳健。
在调整了传统危险因素后，接受高剂量总剂量或日剂量他汀类药物治疗的老年患者新发痴呆病例减少。作用更强的他汀类药物（如阿托伐他汀和瑞舒伐他汀）在预防痴呆方面似乎更为有效。
