Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
Prostate Cancer Prostatic Dis. 2019 May;22(2):276-283. doi: 10.1038/s41391-018-0091-4. Epub 2018 Oct 18.
Androgen deprivation therapy (ADT) has been reported to increase the risk of dementia. Statin use decreases the risk of dementia. This study is aimed to investigate the association of statin use and dementia in type 2 diabetic (T2DM) patients receiving ADT.
Using the National Health Insurance Research Database of Taiwan, we conducted a population-based nationwide cohort study of T2DM patients newly diagnosed with prostate cancer (PCa) between 1998 and 2013. To test statin effects on dementia in T2DM patients receiving ADT, cox proportional hazards models with 1:1 propensity score-matched analysis were used. We divided the study subjects into a statin group and a statin-naive group. The primary outcome was dementia.
Of the 9855 selected T2DM patients newly diagnosed with PCa between 1998 and 2013, 5427 patients received ADT for their PCa. After propensity score matching, 1006 statin users and 1006 non-statin users were included in the study cohort, with a mean follow-up period of 3.5 years for the statin group. Among those patients, 179 (8.7%) were newly diagnosed with dementia. A propensity score-matched analysis (hazard ratio = 0.70, 95% confidence interval = 0.52-0.94) demonstrated a significantly decreased risk of subsequent dementia in the statin users with an absolute risk reduction by 1%. A significant decrease in the risk of dementia with increasing statin duration was also demonstrated (P for trend = 0.002).
Statin use in T2DM patients receiving ADT for PCa had decreased risk of dementia, with statin adherence and intensity augmenting this benefit.
雄激素剥夺疗法（ADT）已被报道会增加痴呆的风险。他汀类药物的使用降低了痴呆的风险。本研究旨在探讨他汀类药物的使用与接受 ADT 的 2 型糖尿病（T2DM）患者发生痴呆之间的关系。
利用台湾全民健康保险研究数据库，我们开展了一项基于人群的全国性队列研究，纳入了 1998 年至 2013 年间新诊断为前列腺癌（PCa）的 T2DM 患者。为了检验 ADT 治疗的 T2DM 患者中他汀类药物对痴呆的影响，采用 Cox 比例风险模型进行了 1:1 倾向评分匹配分析。我们将研究对象分为他汀组和他汀未用组。主要结局是痴呆。
在 1998 年至 2013 年间新诊断为 PCa 的 9855 例 T2DM 患者中，有 5427 例患者接受 ADT 治疗其 PCa。经过倾向评分匹配后，纳入了 1006 例他汀使用者和 1006 例非他汀使用者，他汀组的平均随访时间为 3.5 年。在这些患者中，有 179 例（8.7%）新诊断为痴呆。倾向评分匹配分析（风险比=0.70，95%置信区间=0.52-0.94）表明，他汀使用者发生后续痴呆的风险显著降低（绝对风险降低 1%）。随着他汀类药物使用时间的增加，痴呆的风险也显著降低（趋势检验 P=0.002）。
ADT 治疗 PCa 的 T2DM 患者使用他汀类药物可降低痴呆风险，他汀类药物的依从性和强度增强了这种获益。
