title: Use of Statins and Risk of Dementia in Heart Failure: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Heart failure (HF) is associated with an increased risk of dementia, and studies show that dyslipidemia may be involved in the pathogenesis of dementia. However, it is unclear whether 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are associated with a lower risk of dementia in HF patients. The present study examines the effectiveness of statins to prevent dementia in HF patients.
  
  
  METHODS
  This retrospective longitudinal study used a cohort of patients with HF identified from a local US Medicare Advantage Prescription Drug plan to examine the incidence of dementia with up to 3 years of follow-up. A multivariable time-dependent Cox model and inverse-probability-of-treatment weighting (IPTW) of the marginal structural model were used to estimate the risk of developing dementia. Adjusted dementia rate ratios were estimated among current and former statin users, as compared with nonusers.
  
  
  RESULTS
  The study included a total of 8062 HF patients (mean age 74.47 ± 9.21 years), of whom 1135 (14.08%) were diagnosed with dementia during a median follow-up of 22 months. Using the time-dependent Cox model, the adjusted dementia rate ratios among current and former users were 0.93 (95% confidence interval [CI] 0.71-1.21) and 0.99 (95% CI 0.79-1.25), respectively. Use of IPTW resulted in similar findings of 1.24 (95% conservative CI 0.89-1.72) among current users and 0.94 (95% conservative CI 0.67-1.31) among former users as compared with nonusers.
  
  
  CONCLUSIONS
  This study found no difference in the risk of dementia among current and former users of statins as compared with nonusers in an already at-risk HF population.
authors.affiliation: Retrospective Observational Studies, Evidera, Lexington, MA, USA.
authors.forename: Abhishek S
authors.initials: AS
authors.lastname: Chitnis
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, Department of Clinical Sciences and Administration, University of Houston, College of Pharmacy, 1441 Moursund Street, Houston, TX, 77030, USA.
authors.forename: Rajender R
authors.initials: RR
authors.lastname: Aparasu
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, Department of Clinical Sciences and Administration, University of Houston, College of Pharmacy, 1441 Moursund Street, Houston, TX, 77030, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
authors.affiliation: Houston VA Health Services Research and Development, Center for Innovations in Quality, Effectiveness and Safety, and Development Center of Excellence, Houston, TX, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.affiliation: The University of Texas Health Science Center at Houston, Department of Neurology, Neurocognitive Disorders Center, Houston, TX, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Schulz
authors.affiliation: Department of Pharmaceutical Health Outcomes and Policy, Department of Clinical Sciences and Administration, University of Houston, College of Pharmacy, 1441 Moursund Street, Houston, TX, 77030, USA. mikejohnson@uh.edu.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology* / Q000209:etiology; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors