title: Regarding long-term statin therapy: are we trading stronger hearts for weaker brains?
abstract: Ideally, the benefits of long-term statin therapy should outweigh the risks in all populations. However, some data suggest that long-term statin therapy might promote cerebral small vessel disease and impair myelination, perhaps resulting from cholesterol depletion and pleiotropic effects on amyloid-β metabolism and oligodendrocyte function. The clinical ramifications can be problematic and have a negative impact on the quality of life. Questions are proposed and the answers should be found by analysis of randomized prospective trials specifically investigating the effects of statin therapy on brain structure and function. Those trials should not be funded by drug companies and the investigators should not have financial ties to the pharmaceutical industry. The relevance of the aforementioned is amplified in light of the new cardiovascular guidelines that might culminate in more than a billion people receiving statin therapy worldwide.
authors.affiliation: NCH Physician Group, 1845 Veterans Park Drive, Suite 110, Naples, FL 34109, USA. Electronic address: markrgoldstein@comcast.net.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Goldstein
authors.affiliation: Comando Brigata Alpina "Julia"/Multinational Land Force, Medical Service, 8 Via S. Agostino, Udine 33100, Italy. Electronic address: lumasci@libero.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Mascitelli
mesh_terms: D001812:Blood-Brain Barrier; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000503:physiopathology; D016657:Cerebral Amyloid Angiopathy / Q000503:physiopathology; D002784:Cholesterol / Q000378:metabolism; D006321:Heart / Q000187:drug effects* / Q000502:physiology*; D006706:Homeostasis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000069451:Long Term Adverse Effects; D008279:Magnetic Resonance Imaging; D009836:Oligodendroglia / Q000473:pathology; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D009435:Synaptic Transmission; D066127:White Matter / Q000473:pathology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol