Af Geijerstam Peder, Chalmers John, Pikkemaat Miriam, Peters Ruth, Marre Michel, Mancia Giuseppe, Woodward Mark, Harris Katie
Primary Health Care Center Cityhälsan Centrum, and Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
The George Institute for Global Health, University of New South Wales, Sydney, Australia.
Cardiovasc Diabetol. 2025 Aug 18;24(1):340. doi: 10.1186/s12933-025-02894-3.
Studies on the association between lipid levels and lipid-lowering treatment and the risk of dementia and/or cognitive decline (CD) have shown conflicting results and are few in individuals with type 2 diabetes (T2D). The aim was to evaluate the relationship of baseline LDL cholesterol levels and statin treatment with the development of dementia/CD in patients with T2D from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial.
Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and CD was defined as at least a 3-point decrement in the Mini Mental State Examination score. Exposures were baseline LDL cholesterol levels, statin treatment at baseline, and statin treatment initiation during the first 18 months of follow-up. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% CI for the composite of dementia/CD.
Of 11,140 participants, 1827 (16.4%) developed dementia/CD over the 5-year follow up. The OR (95% CI) of dementia/CD were 1.06 (1.00-1.14) per standard deviation higher in baseline LDL cholesterol and 0.90 (0.79-1.03) for participants with vs without statin treatment.
We observed an association between LDL levels, but not statin treatment, and incident dementia/CD. Although causality cannot be determined by our study, the results are in line with multiple randomised controlled trials. However, to understand the long-term effects of lipid levels and statin treatment on dementia/CD, studies of longer follow-up are still needed.
关于血脂水平、降脂治疗与痴呆症和/或认知功能下降（CD）风险之间关联的研究结果相互矛盾，且在2型糖尿病（T2D）患者中此类研究较少。本研究旨在通过糖尿病和血管疾病行动：培哚普利和达美康缓释片对照评估试验，评估T2D患者的基线低密度脂蛋白胆固醇（LDL-C）水平和他汀类药物治疗与痴呆症/CD发生之间的关系。
采用《精神疾病诊断与统计手册》第4版（DSM-IV）诊断痴呆症，CD定义为简易精神状态检查表得分至少下降3分。暴露因素包括基线LDL-C水平、基线时的他汀类药物治疗以及随访前18个月内开始的他汀类药物治疗。采用多项逻辑回归估计痴呆症/CD复合结局的比值比（OR）和95%置信区间（CI）。
在11140名参与者中，1827名（16.4%）在5年随访期间发生痴呆症/CD。基线LDL-C每升高一个标准差，痴呆症/CD的OR（95%CI）为1.06（1.00 - 1.14）；接受他汀类药物治疗与未接受他汀类药物治疗的参与者相比，OR为0.90（0.79 - 1.03）。
我们观察到LDL水平与新发痴呆症/CD之间存在关联，但他汀类药物治疗与新发痴呆症/CD之间无关联。尽管本研究无法确定因果关系，但结果与多项随机对照试验一致。然而，为了解血脂水平和他汀类药物治疗对痴呆症/CD的长期影响，仍需要进行更长随访期的研究。
