Statins and cognitive function in the elderly: the Cardiovascular Health Study.
OBJECTIVE
To examine the association of statin drug use on cognitive and MRI change in older adults.


METHODS
Participants in the Cardiovascular Health Study, a longitudinal study of people age 65 or older, were classified into three groups determined by whether they were taking statin drugs on a continuous basis, intermittently, or not at all. The untreated group was further divided into categories based on National Cholesterol Education Program recommendations for lipid-lowering treatment. Participants with prevalent or incident clinical TIA or stroke or with baseline Modified Mini-Mental State Examination (3MS) scores at or below 80 were excluded. Outcomes examined included rate of change on the 3MS over an average observational period of 7 years, along with changes in MRI white matter grade and measures of atrophy.


RESULTS
Three thousand three hundred thirty-four participants had adequate data for analysis. At baseline, the untreated group in which lipid-lowering drug treatment was recommended were slightly older, less likely to be on estrogen replacement, and had higher serum cholesterol and lower 3MS scores than the statin-treated group. The rate of decline on the 3MS was 0.48 point/year less in those taking statins compared with the untreated group for which treatment was recommended (p = 0.069) and 0.49 point/year less in statin users compared with the group in which lipid-lowering treatment was not recommended (p = 0.009). This effect remained after controlling for serum cholesterol levels. One thousand seven hundred thirty participants with baseline 3MS scores of > 80 underwent cranial MRI scans on two occasions separated by 5 years. There was no significant difference in white matter grade change or atrophy measures between groups.


CONCLUSIONS
Statin drug use was associated with a slight reduction in cognitive decline in an elderly population. This relationship could not be completely explained by the effect of statins on lowering of serum cholesterol.
Bernick
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Department of Medicine, University of Nevada School of Medicine, Las Vegas, NV 89102, USA. cbernick@med.unr.edu
Katz
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Smith
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Rapp
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Bhadelia
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Carlson
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Kuller
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D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000627:therapeutic use; D001284:Atrophy / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D003072:Cognition Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D015331:Cohort Studies; D003704:Dementia / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D018697:Nootropic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018697:Nootropic Agents; D002784:Cholesterol