From the Journals

Statins protect against Alzheimer’s in most patients



Statins taken to reduce cholesterol also protect most patients against Alzheimer’s disease, but the decrease in risk varies across different statins and by the patient’s gender and race/ethnicity, according to a report published Dec. 12 in JAMA Neurology.

In particular, none of the statins assessed in this study affected the risk of developing Alzheimer’s disease among black men, said Julie M. Zissimopoulos, PhD, and her associates at the University of Southern California, Los Angeles.

Several studies have suggested that statins exert a protective effect against Alzheimer’s, but they have been flawed by insufficient follow-up times and small, nondiverse study populations, so Dr. Zissimopoulos and her colleagues analyzed medical and pharmacy data for a large, diverse sample of Medicare beneficiaries. They focused on 399,979 adults aged 65 and older who initiated statin therapy during a 2-year period and were followed for another 7 years for the development of Alzheimer’s disease. The mean interval between statin exposure and Alzheimer’s diagnosis was 5.4 years.

The study population included 310,240 non-Hispanic white people, 32,658 Hispanic people, 32,278 non-Hispanic black people, and 24,803 people of Asian, Native American, other, or unknown race/ethnicity. The investigators confined their analysis to the four most commonly prescribed statins: simvastatin and atorvastatin, which are both lipophilic, and pravastatin and rosuvastatin, which are both hydrophilic. Overall, 1.72% of women and 1.32% of men were diagnosed as having Alzheimer’s disease during each year of follow-up.

Study participants who were exposed to higher statin levels during the 2-year exposure period were 10% less likely to receive an Alzheimer’s diagnosis during follow-up than were those exposed to lower levels of statins, across all four statins. High exposure to statins reduced the risk of Alzheimer’s among women of all races (hazard ratio, 0.85) and men of all races (HR, 0.88), reflecting 15% and 12% decreases, respectively.

This association, however, varied across gender and race/ethnicity. Statins decreased the risk of Alzheimer’s the most among Hispanic men (HR, 0.71), followed by black women (HR, 0.82), white women (HR, 0.86), and white men (HR, 0.89), but they did not decrease the risk of Alzheimer’s among black men, Dr. Zissimopoulos and her associates said (JAMA Neurol. 2016 Dec 12. doi: 10.1001/jamaneurol.2016.3783). Simvastatin significantly decreased the risk of Alzheimer’s among white, Hispanic, and black women, compared with other subgroups, and atorvastatin significantly decreased the risk among white women, Hispanic women, and Hispanic men. Pravastatin and rosuvastatin only decreased the risk of Alzheimer’s significantly among white women.

These findings suggest that “certain patients, facing multiple, otherwise equal statin alternatives for hyperlipidemia treatment, may reduce Alzheimer’s risk by using a particular statin. The right statin type for the right person at the right time may provide a relatively inexpensive means to lessen the burden of Alzheimer’s disease,” the investigators said.

This study was supported by the National Institute on Aging, the University of Southern California Zumberge Research Fund, and the Schaeffer-Amgen Fellowship Program. Dr. Zissimopoulos and her associates reported having no relevant financial disclosures.

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