From the Guidelines
Risk of Alzheimer's Disease with Statin Use
The risk of Alzheimer's disease in patients taking HMG-CoA reductase inhibitors (statins) is not increased, according to the current evidence.
- Several large randomized trials have shown no differences in cognitive function between statin and placebo groups 1.
- The addition of ezetimibe or PCSK9 inhibitors to statin therapy has also not been associated with cognitive decline 1.
- Systematic reviews of the U.S. Food and Drug Administration's postmarketing surveillance databases, randomized controlled trials, and cohort, case-control, and cross-sectional studies have found no adverse effect of statins on cognition 1.
- Therefore, the use of statins should not be deterred in individuals with diabetes at high risk for ASCVD due to concerns about cognitive dysfunction or dementia 1.
- The most recent and highest quality evidence supports the safety of statins in terms of cognitive function, with no increased risk of Alzheimer's disease or cognitive decline 1.
From the Research
Risk of Alzheimer's Disease in Patients Taking HMG-CoA Reductase Inhibitors (Statins)
The risk of Alzheimer's disease in patients taking HMG-CoA reductase inhibitors (statins) has been investigated in several studies.
- A study published in 2007 2 suggested that statins may reduce the production of beta-amyloid peptide, a major constituent of senile plaques in Alzheimer's disease, through a cholesterol-dependent mechanism.
- However, the same study noted that the cholesterol hypothesis of Alzheimer's disease has not been shown to be valid in clinical trials, and alternative mechanisms, such as vascular contributions or inflammatory pathways, may be involved.
- A systematic review and meta-analysis of observational studies published in 2022 3 found that statin use was associated with a decreased risk of dementia and Alzheimer's disease, with odds ratios of 0.80 and 0.68, respectively.
- Another study published in 2018 4 found that long-term statin use was not associated with differences in Alzheimer's disease biomarkers, but was associated with worse white matter integrity in the genu of the corpus callosum, consistent with higher cerebrovascular risk factor burden.
- A systematic review and updated meta-analysis published in 2025 5 found that statin use significantly reduced the risk of dementia, Alzheimer's disease, and vascular dementia, with hazard ratios of 0.86,0.82, and 0.89, respectively.
- A meta-analysis of observational studies published in 2020 6 found that statin use was associated with a lower risk of all-caused dementia, with a risk ratio of 0.83, and a lower risk of Alzheimer's disease, with a risk ratio of 0.69.
Key Findings
- Statin use is associated with a decreased risk of dementia and Alzheimer's disease 3, 5, 6.
- The mechanisms underlying the potential neuroprotective effects of statins are unclear, but may involve vascular contributions or inflammatory pathways 2.
- Long-term statin use may be associated with worse white matter integrity in the genu of the corpus callosum, consistent with higher cerebrovascular risk factor burden 4.
- The risk reduction associated with statin use may vary depending on factors such as statin type, duration of use, and patient population 3, 5, 6.