Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
J Am Med Dir Assoc. 2024 Mar;25(3):470-479.e1. doi: 10.1016/j.jamda.2023.11.010. Epub 2023 Dec 18.
This study investigated the relationship between statin use and dementia risk in older adults with type 2 diabetes (T2DM). It also assessed the impact of various statin types, dosage intensity, and cumulative doses on dementia risk.
Employing the inverse probability of treatment weighting (IPTW) Cox hazards model, this research explored the influence of statin utilization on dementia incidence.
The study included older adult T2DM patients aged 60 years or older who received statins (case group) and those who did not (control group) during the follow-up period.
The IPTW Cox hazards model quantified the association between statin use and dementia incidence. Subgroup analyses investigated different statin types, usage intensity, and cumulative dose-dependent relationships with dementia risk, measured by adjusted hazard ratios (aHRs) with corresponding 95% CIs.
Statin users experienced a significant reduction in dementia risk (aHR: 0.47, 95% CI: 0.46-0.48). Subgroup analysis using IPTW Cox regression revealed varying dementia incidence reductions among users of different statin types, with aHRs (95% CIs) ranging from 0.09 to 0.69. Multivariate analyses unveiled a dose-dependent relationship, showing reduced dementia incidence based on cumulative defined daily doses (cDDDs) per year. The corresponding aHRs (95% CIs) were 0.20 to 0.72 across quartiles 4 to 1 of cDDD-years, with a significant trend (P < .001). The optimal daily statin use was 0.88 defined daily doses (DDDs), associated with the lowest dementia risk.
Statins significantly reduced dementia risk in older adult T2DM patients. Higher cumulative defined daily doses (cDDD-years) were linked to more substantial risk reductions. This research underscores the clinical benefits of statin use in preventing dementia in this population and calls for further investigation into the underlying mechanisms. It also raises the possibility of influencing policy decisions to manage dementia risk in this vulnerable group.
本研究旨在探讨 2 型糖尿病（T2DM）老年患者使用他汀类药物与痴呆风险之间的关系。同时，评估了不同他汀类药物类型、剂量强度和累积剂量对痴呆风险的影响。
本研究采用逆概率治疗加权（IPTW）Cox 风险模型，探讨了他汀类药物使用对痴呆发生率的影响。
该研究纳入了年龄在 60 岁及以上接受他汀类药物治疗（病例组）和未接受他汀类药物治疗（对照组）的 T2DM 老年患者。
采用 IPTW Cox 风险模型量化了他汀类药物使用与痴呆发生率之间的关联。亚组分析探讨了不同他汀类药物类型、使用强度和累积剂量与痴呆风险之间的关系，采用调整后的危险比（aHR）及其相应的 95%置信区间（CI）进行评估。
他汀类药物使用者痴呆风险显著降低（aHR：0.47，95%CI：0.46-0.48）。采用 IPTW Cox 回归的亚组分析显示，不同他汀类药物类型的使用者痴呆发生率降低程度不同，aHR（95%CI）范围为 0.09-0.69。多变量分析显示，累积剂量依赖性与痴呆发生率降低有关，基于每年累积的限定日剂量（cDDD），aHR（95%CI）分别为 0.20-0.72，呈显著趋势（P<0.001）。他汀类药物的最佳日剂量为 0.88 个 DDD，与痴呆风险最低相关。
他汀类药物可显著降低 T2DM 老年患者的痴呆风险。累积剂量越高，风险降低幅度越大。本研究强调了他汀类药物在预防该人群痴呆方面的临床获益，并呼吁进一步研究其潜在机制。这也为在这一脆弱人群中管理痴呆风险的政策决策提供了参考。
