Statins for the prevention of dementia
McGuinness B, Craig D, Bullock R, Passmore P
The Cochrane database of systematic reviews · 167 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Institute for Health and Care Research
- Gobierno
- National Institute for Health Research (NIHR)
- Subvenciones
- National Institute for Health and Care Research (13/89/22)
Según 2 financiadores declarados.
Publicación
- Publicado
- 2016-01-04 · Cochrane Database Syst Rev · vol. 2016 · número 1 · pág. CD003160
- Editorial
- Elsevier BV
- Citado
- 466 citas · más que el 100% de estudios similares · 38.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 150 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Dementia and Cognitive Impairment Research · Lipoproteins and Cardiovascular Health · Alzheimer's disease research and treatments
- Palabras clave
- statins, dementia prevention, Alzheimer's disease, vascular dementia, simvastatin, pravastatin, cholesterol, APOE genotype, cognitive function, adverse events, statin safety, vascular risk factors, older adults, hypercholesterolemia, lipid-lowering therapy, cognitive decline, dementia incidence, treatment discontinuation
- MeSH
- humans, dementia, alzheimer disease, simvastatin, pravastatin, anticholesteremic agents, hydroxymethylglutaryl-coa reductase inhibitors, cognition, adult, aged, aged, 80 and over, middle aged, randomized controlled trials as topic
4 autores
- Bernadette McGuinness🇬🇧Queen's University Belfast
- David Craig🇬🇧Craigavon Area Hospital
- Roger Alan Bullock🇬🇧Victoria Hospital
- Peter Passmore🇬🇧Queen's University Belfast
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
This is an update of a Cochrane review first published in 2001 and then updated in 2009. Vascular risk factors including high cholesterol levels increase the risk of dementia due to Alzheimer's disease and of vascular dementia. Some observational studies have suggested an association between statin use and lowered incidence of dementia.
Objectives
To evaluate the efficacy and safety of statins for the prevention of dementia in people at risk of dementia due to their age and to determine whether the efficacy and safety of statins for this purpose depends on cholesterol level, apolipoprotein E (ApoE) genotype or cognitive level.
Search methods
We searched ALOIS (the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, ClinicalTrials.gov and the World Health Organization (WHO) Portal on 11 November 2015.
Selection criteria
We included double-blind, randomised, placebo-controlled trials in which statins were administered for at least 12 months to people at risk of dementia.
Data collection and analysis
We used standard methodological procedures expected by Cochrane.
Main results
We included two trials with 26,340 participants aged 40 to 82 years of whom 11,610 were aged 70 or older. All participants had a history of, or risk factors for, vascular disease. The studies used different statins (simvastatin and pravastatin). Mean follow-up was 3.2 years in one study and five years in one study. The risk of bias was low. Only one study reported on the incidence of dementia (20,536 participants, 31 cases in each group; odds ratio (OR) 1.00, 95% confidence interval (CI) 0.61 to 1.65, moderate quality evidence, downgraded due to imprecision). Both studies assessed cognitive function, but at different times using different scales, so we judged the results unsuitable for a meta-analysis. There were no differences between statin and placebo groups on five different cognitive tests (high quality evidence). Rates of treatment discontinuation due to non-fatal adverse events were less than 5% in both studies and there was no difference between statin and placebo groups in the risk of withdrawal due to adverse events (26,340 participants, 2 studies, OR 0.94, 95% CI 0.83 to 1.05).
Authors' conclusions
There is good evidence that statins given in late life to people at risk of vascular disease do not prevent cognitive decline or dementia. Biologically, it seems feasible that statins could prevent dementia due to their role in cholesterol reduction and initial evidence from observational studies was very promising. However, indication bias may have been a factor in these studies and the evidence from subsequent RCTs has been negative. There were limitations in the included studies involving the cognitive assessments used and the inclusion of participants at moderate to high vascular risk only.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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