From the Guidelines
Statin use is not associated with an increased risk of dementia and should not be withheld from patients who require them for cardiovascular disease management, as the current evidence does not support a causal link between statin use and cognitive decline. The most recent systematic review, as reported in the 2023 standards of care in diabetes 1, found that published data do not reveal an adverse effect of statins on cognition, including dementia. Several large randomized trials of statin versus placebo have shown no differences in cognitive function between the two groups. Additionally, studies that added ezetimibe or PCSK9 inhibitors to statin therapy, even at very low LDL cholesterol levels, reported no change in cognitive function.
Key points to consider when evaluating the relationship between statin use and dementia include:
- The lack of evidence supporting an adverse effect of statins on cognition, as demonstrated by multiple lines of evidence, including randomized controlled trials and systematic reviews 1
- The importance of managing cardiovascular risk factors, including cholesterol levels, to prevent vascular dementia through stroke reduction
- The complex relationship between cholesterol and brain health, with high midlife cholesterol associated with increased dementia risk, but very low cholesterol in later life potentially correlating with cognitive decline in some studies
In clinical practice, statins should be prescribed based on their established benefits for managing cholesterol and reducing cardiovascular risk, rather than for the prevention of dementia. Patients who are already taking statins for cardiovascular indications should continue as prescribed, but adding statins specifically to prevent dementia is not supported by current evidence. Maintaining overall cardiovascular health through multiple approaches, including appropriate statin use when indicated for heart health, remains the best strategy for supporting brain health.
From the Research
Statin Use and Dementia Risk
- The use of statins has been associated with a reduced risk of dementia in several studies 2, 3, 4, 5.
- A study published in the Lancet found that individuals aged 50 and older who were prescribed statins had a substantially lowered risk of developing dementia, independent of the presence or absence of untreated hyperlipidaemia or exposure to non-statin lipid-lowering agents 2.
- Another study published in the Journal of Internal Medicine found that statin use was associated with a decreased risk of newly diagnosed dementia in an elderly population, with a significant inverse association between total or daily equivalent statin dosage and dementia risk 3.
Mechanisms and Potential Benefits
- The mechanisms by which statins may confer protective effects against dementia are unclear, but may be related to their effects on cerebral cholesterol metabolism 6.
- Some studies suggest that certain types of statins, such as atorvastatin and rosuvastatin, may be more effective in reducing the risk of dementia than others 3, 4.
- The combination of statins with antihypertensive therapy may also be associated with a reduced risk of Alzheimer's disease and related dementias 4.
Study Findings and Meta-Analyses
- A systematic review and meta-analysis of observational studies found that statin use was associated with a decreased risk of dementia and Alzheimer's disease, with no difference in risk reduction between men and women 5.
- The meta-analysis also found that high-potency statins may be more effective in reducing the risk of dementia than low-potency statins, although the difference was not statistically significant 5.
- Overall, the evidence suggests that statin use may be associated with a reduced risk of dementia, although further research is needed to confirm this association and to understand the underlying mechanisms 2, 3, 6, 4, 5.