Vaage Anders Myhre, Holmøy Trygve, Dahl Jesper, Stigum Hein, Meyer Haakon E, Nakken Ola
Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur J Neurol. 2025 Mar;32(3):e70095. doi: 10.1111/ene.70095.
Dyslipidemia is common in amyotrophic lateral sclerosis (ALS). Statin use has been associated with both favorable and poor prognoses. We assessed whether statin use affects ALS survival.
We linked four Norwegian health surveys (1972-2003) with mandatory national registries to obtain information on premorbid health, ALS diagnosis, and death. Using the Norwegian Prescribed Drug Registry, we identified participants who had dispensed statins pre- and post-diagnosis. We first compared pre-diagnosis statin discontinuation rates between ALS patients and matched controls. Flexible parametric models were then fitted to estimate the relationship between statin use and survival time in ALS, using restricted mean survival time and hazard ratio (HR) as effect measures.
A total of 524 patients (43% female) with ALS were included. Mean time from ALS diagnosis to death or end of study was 2.0 (SD 2.1) years. A substantial proportion of statin users (21%) discontinued statins during the year leading up to diagnosis. This group was characterized by poorer ALS prognosis compared to those adhering to statins and were included as statin users in our analysis. After adjusting for sex, age, birth year, riluzole use and premorbid smoking status, body mass index, and total cholesterol levels, statin use was not associated with ALS survival. The estimated mean survival difference comparing statin users to non-users was 0.74 (95% CI -5.98 to 7.47) months, corresponding to a HR of 0.97 (95% CI 0.77-1.23).
Statin use was not associated with ALS survival, suggesting that statins should not routinely be discontinued in ALS.
血脂异常在肌萎缩侧索硬化症（ALS）中很常见。使用他汀类药物与预后良好和不良均有关联。我们评估了他汀类药物的使用是否会影响ALS患者的生存期。
我们将四项挪威健康调查（1972 - 2003年）与国家强制登记系统相链接，以获取病前健康状况、ALS诊断和死亡信息。利用挪威处方药登记系统，我们确定了在诊断前后使用他汀类药物的参与者。我们首先比较了ALS患者与匹配对照在诊断前停用他汀类药物的比率。然后使用灵活的参数模型，以受限平均生存时间和风险比（HR）作为效应量，来估计他汀类药物使用与ALS患者生存时间之间的关系。
共纳入524例ALS患者（43%为女性）。从ALS诊断到死亡或研究结束的平均时间为2.0（标准差2.1）年。相当一部分他汀类药物使用者（21%）在诊断前一年停用了他汀类药物。与坚持使用他汀类药物的患者相比，这一组的ALS预后较差，在我们的分析中被纳入他汀类药物使用者。在调整了性别、年龄、出生年份、利鲁唑使用情况、病前吸烟状况、体重指数和总胆固醇水平后，他汀类药物的使用与ALS患者的生存期无关。他汀类药物使用者与非使用者的估计平均生存差异为0.74（95%置信区间 -5.98至7.47）个月，对应的HR为0.97（95%置信区间0.77 - 1.23）。
他汀类药物的使用与ALS患者的生存期无关，这表明在ALS患者中不应常规停用他汀类药物。
