Statins Seem to Reduce Alzheimer’s Disease Risk, But Race/Ethnicity and Statin Type Matter

A new analysis of Medicare claims supports the idea that statin therapy reduces the risk of developing Alzheimer’s disease (AD), but it also shows that the magnitude of potential benefit varies based on the racial/ethnic background and sex of patients and statin type.

In white women, for example, high versus low exposure to any of the four most commonly prescribed statins was associated with a lower risk of AD, whereas no apparent benefit was seen with the drugs in black men, lead author Julie Zissimopoulos, PhD (University of Southern California, Los Angeles), and colleagues report in a study published online December 12, 2016, ahead of print in JAMA Neurology. Relationships varied for other subgroups.

Significant associations were more consistently seen for simvastatin and atorvastatin than for pravastatin and rosuvastatin. Nevertheless, Zissimopoulos told TCTMD, all of the statins seemed to carry some benefit.

“I don’t think that this study can say, use this statin and don’t use that statin, but it does suggest that there might be some differences across statins that are worth considering,” she said, noting that “even small reductions in risk can make a huge difference for individuals and for society as a whole both around health and healthcare costs.”

Attempts to develop an effective treatment for AD, largely focused on modifying beta-amyloid in the brain, have thus far failed. There is some evidence to suggest that statin therapy may lower the risk of AD, potentially through a mechanism involving the link between serum cholesterol levels and beta-amyloid deposition. But prior studies exploring the relationship between statins and AD have provided inconclusive results, Zissimopoulos said.

In the current study, the investigators examined medical and pharmacy claims data from a 20% sample of Medicare beneficiaries—399,979 patients aged 65 years or older who had either high or low exposure to statins during the study period.

Over a mean follow-up of 7.2 years, AD was diagnosed in 1.72% of women and 1.32% of men each year. Rates were highest in Hispanic and black individuals.

After adjustment, high exposure to statins was associated with a lower risk of developing AD in both women (HR 0.85; 95% CI 0.82-0.89) and men (HR 0.88; 95% CI 0.83-0.93), but there was variation by race/ethnicity. With all statins grouped together, a lower risk of AD was seen with treatment in Hispanic and white men and in black and white women. Relationships in other groups fell short of statistical significance.

Considered individually, the lipophilic statins—simvastatin and atorvastatin—seemed to have a broader impact while their hydrophilic counterparts—pravastatin and rosuvastatin—were associated with a lower risk of AD in white women only.

Zissimopoulos said that she hopes the study will encourage more clinical trials looking at the potential benefit of statins—which are easily accessed by patients at low cost—in reducing AD risk and also boost enrollment of groups from different racial and ethnic backgrounds.

Sources
  • Zissimopoulos JM, Barthold D, Brinton RD, Joyce G. Sex and race differences in the association between statin use and the incidence of Alzheimer disease. JAMA Neurol. 2016;Epub ahead of print.

Disclosures
  • The study was supported by the National Institute on Aging and the University of Southern California Zumberge Research Fund.
  • Zissimopoulos reports no relevant conflicts of interest.

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