Does the use of HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors, commonly referred to as statins, reduce the risk of dementia?

From the Guidelines

Statin use is not associated with a significant reduction in dementia risk, and its primary benefit remains in cardiovascular disease prevention. The US Preventive Services Task Force found no clear evidence of decreased cognitive function associated with statin use, and a systematic review of RCTs and observational studies assessing the effect of statins on cognition found no effect on incidence of Alzheimer disease or dementia 1. While some observational studies may suggest a potential link between statin use and reduced dementia risk, the evidence is not conclusive, and statins should primarily be taken for their proven cardiovascular benefits. The potential harms of statin use, such as myalgia and increased risk of diabetes with high-dose statins, should be weighed against their benefits 1.

Key points to consider:

• Statin use is not associated with serious adverse events such as cancer, severely elevated liver enzyme levels, or severe muscle-related harms in adults aged 40 to 75 years 1
• Evidence concerning the association between statin use and diabetes mellitus is mixed, with a potential small increased risk of developing diabetes with use of high-dose statins 1
• Myalgia is a commonly reported adverse effect of statins, but placebo-controlled trial data do not support the conclusion that statin use has a major causative role in its occurrence 1
• The cognitive benefits of statins, if any, likely result from preventing small vessel disease and strokes that contribute to vascular dementia, rather than a direct effect on dementia prevention.

In clinical practice, the decision to prescribe statins should be based on their proven benefits in reducing cardiovascular risk, rather than their potential effects on dementia risk. Individuals with cardiovascular risk factors may still benefit from statin use, but the potential benefits and harms should be carefully weighed and discussed with a healthcare provider.

From the Research

Statin Use and Dementia Risk Reduction

• The relationship between statin use and dementia risk reduction is complex, with some studies suggesting a potential benefit and others finding no association 2, 3.
• A 2023 study published in PloS one found that ongoing statin use was not associated with cognitive decline or dementia progression in older adults with mild-moderate Alzheimer's disease 2.
• In contrast, a 2025 systematic review and meta-analysis published in Alzheimer's & dementia found that statin use was associated with a significant reduction in the risk of dementia, Alzheimer's disease, and vascular dementia 3.
• The meta-analysis included 55 observational studies with over 7 million patients and found that statin use reduced the risk of dementia by 14% compared to nonusers 3.
• Subgroup analyses revealed that the protective effect of statins was more pronounced in patients with type 2 diabetes mellitus, those with exposure to statins for more than 3 years, and populations from Asia 3.

Mechanisms and Potential Benefits

• Statins may have neuroprotective effects by reducing inflammation, improving blood flow, and preventing the formation of beta-amyloid plaques, which are characteristic of Alzheimer's disease 4, 3.
• The potential benefits of statins in dementia prevention are supported by observational studies and meta-analyses, but randomized clinical trials are needed to confirm these findings 3.
• The use of statins as a public health tool to prevent dementia is an area of ongoing research, with potential implications for low-income countries where access to healthcare may be limited 3.

Limitations and Future Directions

• The current evidence on statin use and dementia risk reduction is largely based on observational studies, which are subject to biases and limitations 2, 3.
• Randomized clinical trials are needed to establish causality and determine the efficacy of statins in preventing dementia 3.
• Future studies should explore the impact of statins on dementia risk in diverse patient populations, including those with different types of dementia and comorbidities 3.