Ren Qing-Wen, Katherine Teng Tiew-Hwa, Tse Yi-Kei, Wei Tsang Christopher Tze, Yu Si-Yeung, Wu Mei-Zhen, Li Xin-Li, Hung Denise, Tse Hung-Fat, Lam Carolyn S P, Yiu Kai-Hang
Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Lancet Reg Health West Pac. 2024 Jan 17;44:101006. doi: 10.1016/j.lanwpc.2023.101006. eCollection 2024 Mar.
Heart failure (HF) and dementia frequently co-exist with shared pathological mechanisms and risk factors. Our study aims to investigate the association between statin therapy and the risks of dementia and its subtypes among patients with HF.
The Hong Kong Clinical Data Analysis and Reporting System database was interrogated to identify patients with incident HF diagnosis from 2004 to 2018, using ICD 9/ICD 10 codes. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between statin users (N = 54,004) and non-users (N = 50,291). The primary outcomes were incident all-cause dementia, including subtypes of Alzheimer's disease, vascular dementia, and unspecified dementia. Cox proportional-hazard model with competing risk regression was performed to estimate the sub-distribution hazards ratio (SHR) with corresponding 95% confidence intervals (CI) of the risks of all-cause dementia and its subtypes that are associated with statin use.
Of all eligible patients with HF (N = 104,295), the mean age was 74.2 ± 13.6 years old and 52,511 (50.3%) were male. Over a median follow-up of 9.9 years (interquartile range [IQR]: 6.4-13.0), 10,031 (9.6%) patients were diagnosed with dementia, among which Alzheimer's disease (N = 2250), vascular dementia (N = 1831), and unspecified dementia (N = 5950) were quantified separately. After IPTW, statin use was associated with a 20% lower risk of incident dementia compared with non-use (multivariable-adjusted SHR 0.80, 95% CI 0.76-0.84). Stratified by subtypes of dementia, statin use was associated with a 28% lower risk of Alzheimer's disease (SHR 0.72, 95% CI 0.63-0.82), 18% lower risk of vascular dementia (SHR 0.82, 95% CI 0.70-0.95), and a 20% lower risk of unspecified dementia (SHR 0.80, 95% CI 0.75-0.85).
In patients with HF, statin use was associated with a significantly lower risk of all-cause dementia and its subtypes, including Alzheimer's disease, vascular dementia, and unspecified dementia. Both randomized trials and experimental studies to validate the potential neuroprotective effect of statin are warranted.
No funding was provided for this study.
心力衰竭（HF）和痴呆症常并存，存在共同的病理机制和风险因素。我们的研究旨在调查他汀类药物治疗与HF患者痴呆症及其亚型风险之间的关联。
利用国际疾病分类第9版/第10版（ICD 9/ICD 10）编码，查询香港临床数据分析与报告系统数据库，以识别2004年至2018年确诊为HF的患者。采用治疗权重反概率法（IPTW）平衡他汀类药物使用者（N = 54,004）和非使用者（N = 50,291）之间的基线协变量。主要结局为全因性痴呆症发病，包括阿尔茨海默病、血管性痴呆和未特定类型痴呆症的亚型。采用带有竞争风险回归的Cox比例风险模型，估计与使用他汀类药物相关的全因性痴呆症及其亚型风险的亚分布风险比（SHR）及相应的95%置信区间（CI）。
在所有符合条件的HF患者（N = 104,295）中，平均年龄为74.2±13.6岁，男性有52,511名（50.3%）。在9.9年（四分位间距[IQR]：6.4 - 13.0）的中位随访期内，10,031名（9.6%）患者被诊断为痴呆症，其中分别对阿尔茨海默病（N = 2250）、血管性痴呆（N = 1831）和未特定类型痴呆症（N = 5950）进行了量化。IPTW后，与未使用他汀类药物相比，使用他汀类药物与痴呆症发病风险降低20%相关（多变量调整后的SHR为0.80，95%CI为0.76 - 0.84）。按痴呆症亚型分层，使用他汀类药物与阿尔茨海默病风险降低28%（SHR为0.72，95%CI为0.63 - 0.82）、血管性痴呆风险降低18%（SHR为0.82，95%CI为0.70 - 0.95）以及未特定类型痴呆症风险降低20%（SHR为0.80，95%CI为0.75 - 0.85）相关。
在HF患者中，使用他汀类药物与全因性痴呆症及其亚型（包括阿尔茨海默病、血管性痴呆和未特定类型痴呆症）的风险显著降低相关。有必要开展随机试验和实验研究来验证他汀类药物潜在的神经保护作用。
本研究未获得资金支持。
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