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Lower cholesterol -- lower dementia
Title: Statins and the risk of dementia
Author: H. Jick, et al.
Address: Lexington, MA
Source: The Lancet 356:1627-1631 (November) 2000
Summary: It is estimated that dementia affects 10% of the population older than 65 years and vascular and lipid-related mechanisms are thought to have a role in the pathogenesis of Alzheimer's disease and vascular dementia. Thus, researchers conducted a study of the potential effect of HMG CoA (3 hydroxy-3menthylglutaryl-coenzyme A) reductase inhibitors (statins) and other lipid-lowering agents on dementia. The study population initially included 3 groups who were 50 years and older. Group 1 consisted of all individuals who had received lipid-lowering agents; group 2 included all individuals with a clinical diagnosis of untreated hyperlipidaemia; and group 3 was a randomly selected group of other individuals. From these three groups, all cases with a computer recorded clinical diagnosis of dementia were identified. Each case was matched with as many as four controls derived from the base population on age, sex, practice, and index date of case. Included in the study were 284 subjects with dementia and 1,080 controls. 13% of the controls had untreated hyperlipidaemia, 11% were prescribed statins, 7% other LLAs, and 69% had no hyperlipidaemia or LLA exposure. Researchers found that individuals 50 years and older who were prescribed statins had a substantially lower risk of developing dementia, independent of the presence or absence of untreated hyperlipidaemia or exposure to non-statin LLAs. However, the available data do not distinguish between Alzheimer's disease and other forms of dementia.
Comment: This reminds me of a cartoon of a physician looking over his desk and telling a perimenopausal patient, "I'm going to take you off additives and put you on preservatives." An interesting comparison might be made with HRT. Both are needed because of our extended life expectancy and to help extend it. Both have benefits greater than the reason for which they are indicated. Both are associated with unwanted side-effects. It is too early to know the impact of lipid lowering agents on large populations over many years. The frontier of pharmaceutical research is drugs to acclimate our genetic predispositions into our 21st century lifestyle.