title: Sex and Race Differences in the Association Between Statin Use and the Incidence of Alzheimer Disease.
abstract: To our knowledge, no effective treatments exist for Alzheimer disease, and new molecules are years away. However, several drugs prescribed for other conditions have been associated with reducing its risk.
  
  
  
  To analyze the association between statin exposure and Alzheimer disease incidence among Medicare beneficiaries.
  
  
  
  We examined the medical and pharmacy claims of a 20% sample of Medicare beneficiaries from 2006 to 2013 and compared rates of Alzheimer disease diagnosis for 399 979 statin users 65 years of age or older with high or low exposure to statins and with drug molecules for black, Hispanic, and non-Hispanic white people, and men and women of Asian, Native American, or unkown race/ethnicity who are referred to as "other."
  
  
  
  The main outcome was incident diagnosis of Alzheimer disease based on the International Classification of Diseases, Ninth Revision, Clinical Modification. We used Cox proportional hazard models to analyze the association between statin exposure and Alzheimer disease diagnosis for different sexes, races and ethnicities, and statin molecules.
  
  
  
  The 399 979 study participants included 7794 (1.95%) black men, 24 484 (6.12%) black women, 11 200 (2.80%) Hispanic men, 21 458 (5.36%) Hispanic women, 115 059 (28.77%) white men, and 195 181 (48.80%) white women. High exposure to statins was associated with a lower risk of Alzheimer disease diagnosis for women (hazard ratio [HR], 0.85; 95% CI, 0.82-0.89; P<.001) and men (HR, 0.88; 95% CI, 0.83-0.93; P<.001). Simvastatin was associated with lower Alzheimer disease risk for white women (HR, 0.86; 95% CI, 0.81-0.92; P<.001), white men (HR, 0.90; 95% CI, 0.82-0.99; P=.02), Hispanic women (HR, 0.82; 95% CI, 0.68-0.99; P=.04), Hispanic men (HR, 0.67; 95% CI, 0.50-0.91; P=.01), and black women (HR, 0.78; 95% CI, 0.66-0.93; P=.005). Atorvastatin was associated with a reduced risk of incident Alzheimer disease diagnosis for white women (HR, 0.84, 95% CI, 0.78-0.89), black women (HR, 0.81, 95% CI, 0.67-0.98), and Hispanic men (HR, 0.61, 95% CI, 0.42-0.89) and women (HR, 0.76, 95% CI, 0.60-0.97). Pravastatin and rosuvastatin were associated with reduced Alzheimer disease risk for white women only (HR, 0.82, 95% CI, 0.70-0.95 and HR, 0.81, 95% CI, 0.67-0.98, respectively). High statin exposure was not associated with a statistically significant lower Alzheimer disease risk among black men.
  
  
  
  The reduction in Alzheimer disease risk varied across statin molecules, sex, and race/ethnicity. Clinical trials that include racial and ethnic groups need to confirm these findings. Because statins may affect Alzheimer disease risk, physicians should consider which statin is prescribed to each patient.
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Zissimopoulos
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
authors.forename: Douglas
authors.initials: D
authors.lastname: Barthold
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles2Center for Innovation in Brain Science, University of Arizona Health Sciences, Tucson.
authors.forename: Roberta Diaz
authors.initials: RD
authors.lastname: Brinton
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Joyce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D001213:Asian; D044383:Black People; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012727:Sex Characteristics; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors