Is Crestor (rosuvastatin) associated with an increased risk of dementia?

Rosuvastatin (Crestor) and Dementia Risk

Current evidence does not support an association between rosuvastatin (Crestor) or other statins and an increased risk of dementia. In fact, some evidence suggests statins may have a protective effect against dementia in certain populations. 1

Evidence on Statins and Cognitive Function

Guideline Recommendations

• Multiple clinical guidelines explicitly state that concerns about cognitive effects should not deter statin use in appropriate patients:
  • The 2020 Diabetes Care guidelines state: "A concern that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia is not currently supported by evidence and should not deter their use in individuals with diabetes at high risk for ASCVD." 2
  • The 2025 Diabetes Care guidelines maintain this position, citing multiple lines of evidence against cognitive impairment with statin use 2

Clinical Trial Evidence

• Three large randomized controlled trials specifically examining cognitive function found no differences between statin and placebo groups 1
• A systematic review of the FDA's postmarketing surveillance databases, randomized controlled trials, and cohort studies found no adverse effect of statins on cognition 2
• No cognitive changes were observed when ezetimibe or PCSK9 inhibitors were added to statin therapy, even in patients treated to very low LDL cholesterol levels 2

Specific Evidence for Rosuvastatin

• In a large-scale nationwide cohort study of patients with atrial fibrillation, rosuvastatin was associated with the largest risk reduction for non-vascular dementia compared to other statins (adjusted HR=0.661) 3
• The JUPITER trial, which specifically studied rosuvastatin, found that while there was a small absolute risk increase for diabetes (1.2% on placebo vs 1.5% on rosuvastatin over 5 years), there was no evidence of cognitive impairment 2

Weighing Benefits vs. Potential Risks

Cardiovascular Benefits

• Statins, including rosuvastatin, have well-established benefits in reducing cardiovascular events and mortality in appropriate patients 2
• The US Preventive Services Task Force found moderate certainty that initiating low- to moderate-dose statins for primary prevention in adults aged 40-75 years with cardiovascular risk factors has at least a moderate net benefit 2

Potential Concerns

• While some observational studies have suggested a link between statins and cognitive effects, randomized controlled trials have consistently failed to confirm these associations 4, 5
• A 2021 study of 18,846 adults ≥65 years found that statin use was not associated with incident dementia, mild cognitive impairment, or declines in individual cognition domains 6

Clinical Implications

Patient Monitoring

• While rare idiosyncratic cognitive reactions may occur with statin therapy, these do not represent a class effect and should not prevent appropriate statin use 1
• If a patient reports new cognitive symptoms while on rosuvastatin, temporary discontinuation may be considered to assess whether symptoms improve, followed by rechallenge or switch to another statin if appropriate 1

Special Populations

• In older adults (≥65 years), a recent large study found no association between statin therapy and incident dementia or cognitive decline 6
• For patients with atrial fibrillation, statin use (particularly rosuvastatin) may actually be associated with a lower risk of non-vascular dementia 3

In conclusion, the highest quality and most recent evidence indicates that rosuvastatin does not increase the risk of dementia, and concerns about cognitive effects should not prevent its use in patients who would benefit from statin therapy for cardiovascular risk reduction.