Westphal Filho Fernando Luiz, Moss Lopes Paulo Roberto, Menegaz de Almeida Artur, Sano Vitor Kendi Tsuchiya, Tamashiro Fernanda Moraes, Gonçalves Ocílio Ribeiro, de Moraes Francisco Cezar Aquino, Kreuz Michele, Kelly Francinny Alves, Silveira Feitoza Pablo Vinícius
Department of Clinical Surgery School of Medicine Federal University of Amazonas Manaus Amazonas Brazil.
School of Medicine Federal University of Mato Grosso Sinop, Mato Grosso Brazil.
Alzheimers Dement (N Y). 2025 Jan 16;11(1):e70039. doi: 10.1002/trc2.70039. eCollection 2025 Jan-Mar.
Dementia affects 55 million people globally, with the number projected to triple by 2050. Statins, widely prescribed for cardiovascular benefits, may also have neuroprotective effects, although studies on their impact on dementia risk have shown contradictory results. In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed the risk of dementia, Alzheimer's disease (AD), and vascular dementia (VaD), with subgroup analyses by gender, statin type, and diabetes status. Fifty-five observational studies including over 7 million patients were analyzed. Statin use significantly reduced the risk of dementia compared to nonusers (hazard ratio [HR] 0.86; 95% confidence interval [CI]: 0.82 to 0.91; < 0.001). It was also associated with reduced risks of AD (HR 0.82; 95% CI: 0.74 to 0.90; < 0.001) and VaD (HR 0.89; 95% CI: 0.77 to 1.02; = 0.093). Subgroup analyses revealed significant dementia risk reductions among patients with type 2 diabetes mellitus (HR 0.87; 95% CI: 0.85 to 0.89; < 0.001), those with exposure to statins for more than 3 years (HR 0.37; 95% CI: 0.30 to 0.46; < 0.001), and populations from Asia, where the greatest protective effect was observed (HR 0.84; 95% CI: 0.80 to 0.88). Additionally, rosuvastatin demonstrated the most pronounced protective effect for all-cause dementia among specific statins (HR 0.72; 95% CI: 0.60 to 0.88). Our findings underscore the neuroprotective potential of statins in dementia prevention. Despite the inherent limitations of observational studies, the large dataset and detailed subgroup analyses enhance the reliability of our results. Future randomized clinical trials are necessary to confirm these findings and enlighten clinical guidelines.
Largest meta-analysis to date on statins and dementia risk, including 55 studies and more than 7 million patients.Statin use linked to lower risks of all-dementia, AD, and VaD.Numerous significant subgroup results highlight statins' diverse neuroprotective effects.Findings support statins as a public health tool, especially in low-income countries.Future research should explore the impact of statins across diverse patient populations.
痴呆症在全球影响着5500万人，预计到2050年这一数字将增至三倍。他汀类药物因对心血管有益而被广泛处方，可能也具有神经保护作用，尽管关于其对痴呆症风险影响的研究结果相互矛盾。在这项系统评价和荟萃分析中，我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索了PubMed、Embase和Cochrane数据库。我们评估了痴呆症、阿尔茨海默病（AD）和血管性痴呆（VaD）的风险，并按性别、他汀类药物类型和糖尿病状态进行亚组分析。分析了55项观察性研究，涉及超过700万患者。与未使用者相比，使用他汀类药物显著降低了痴呆症风险（风险比[HR]0.86；95%置信区间[CI]：0.82至0.91；P<0.001）。它还与AD风险降低（HR 0.82；95%CI：0.74至0.90；P<0.001）和VaD风险降低（HR 0.89；95%CI：0.77至1.02；P=0.093）相关。亚组分析显示，2型糖尿病患者（HR 0.87；95%CI：0.85至0.89；P<0.001）、使用他汀类药物超过3年的患者（HR 0.37；95%CI：0.30至0.46；P<0.001）以及亚洲人群（观察到最大保护作用，HR 0.84；95%CI：0.80至0.88）的痴呆症风险显著降低。此外，在特定他汀类药物中，瑞舒伐他汀对全因性痴呆的保护作用最为显著（HR 0.72；95%CI：0.60至0.88）。我们的研究结果强调了他汀类药物在预防痴呆症方面的神经保护潜力。尽管观察性研究存在固有局限性，但庞大的数据集和详细的亚组分析提高了我们结果的可靠性。未来需要进行随机临床试验来证实这些发现并为临床指南提供指导。
迄今为止关于他汀类药物与痴呆症风险的最大规模荟萃分析，包括55项研究和超过700万患者。使用他汀类药物与降低全痴呆症、AD和VaD风险相关。众多显著的亚组结果突出了他汀类药物多样的神经保护作用。研究结果支持将他汀类药物作为一种公共卫生工具，尤其是在低收入国家。未来的研究应探索他汀类药物对不同患者群体的影响。
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