Statins may not benefit older adults with dementia
Nursing home residents with dementia who were taking statins were at higher risk for cardiovascular and cerebrovascular hospitalization than those not on the medications, a German retrospective cohort study found.
Statins may increase risk for hospitalization in older patients with dementia, according to a recent study.
Researchers in Germany used insurance claims to conduct a retrospective cohort study of nursing home residents with and without dementia between January 2015 and December 2019. The goal of the study was to evaluate the association of statin use with hospitalizations due to cerebrovascular and cardiovascular events. Subgroup analyses looked at the presence or absence of atherosclerotic cardiovascular disease, dementia type, presence of hyperlipidemia, and newly prescribed statin use, as well as age, level of care dependency, and sex. The results were published Nov. 17 by Stroke.
A total of 96,162 patients, 58,900 with and 37,262 without dementia, were included in the study. Mean age was 83.4 years and 82.2 years, respectively, and 69.8% and 66.9% were women. Hyperlipidemia had been diagnosed in 71.1% and 66.2%. Use of statins was associated with an increased risk of hospitalization due to cardiovascular or cerebrovascular events for patients with dementia (hazard ratio [HR], 1.06 [95% CI, 1.01 to 1.12]; P=0.023), and that risk increased with higher-intensity therapy (HRs, 1.15 [95% CI, 1.07 to 1.23] for moderate-intensity statins [P<0.001] and 1.55 [95% CI, 1.15 to 2.10] for high-intensity statins [P=0.005]).
Subgroup analyses found associations between statin use and hospitalization risk in patients without atherosclerotic cardiovascular disease (HR, 1.30 [95% CI, 1.12 to 1.52]; P<0.001), with vascular dementia (HR, 1.18 [95% CI, 1.06 to 1.32]; P=0.003]), and with Alzheimer disease (HR, 1.14 [95% CI, 1.00 to 1.31]; P=0.047), as well as in those newly prescribed statins (HR, 2.71 [95% CI, 2.33 to 3.15]; P<0.001). No associations with hospitalization were seen among patients without dementia except for those taking high-intensity statins (HR, 1.51 [95% CI, 1.04 to 2.19]; P=0.029) and those who had newly been prescribed statins (HR, 1.99 [95% CI, 1.56 to 2.52]; P<0.001).
Limitations include that the results could have been affected by survival bias, that information on dementia severity was not available, and that the number of events was low, the authors noted.
“In conclusion, our study suggests no benefit of statins in [patients with dementia], and in fact, the present findings indicate an association between statin use and an increased risk of hospitalization due to cardiovascular or cerebrovascular events” in this population, they wrote. They cautioned that their findings must be considered in the context of the study's limitations and that clinicians should assess individual risks and benefits when considering statin use, especially new prescriptions, in older people with dementia. “Larger and more heterogeneous samples and prospective studies are needed to confirm these findings and clarify the underlying mechanisms,” they wrote.