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Statins and risks of dementia among patients with heart failure: a population-based retrospective cohort study in
Qing-Wen Ren1,2, Tiew-Hwa Katherine Teng3,4,5, Yi-Kei Tse2
1Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
Insights
Statin therapy in heart failure patients significantly reduces the risk of developing dementia, including Alzheimer's and vascular dementia. Further research is recommended to confirm these neuroprotective effects.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Heart failure (HF) and dementia share common pathological mechanisms and risk factors.
- Investigating the impact of statin therapy on dementia risk in HF patients is crucial.
Purpose of the Study:
- To examine the association between statin use and the incidence of all-cause dementia and its subtypes in patients diagnosed with heart failure.
- To evaluate the potential neuroprotective effects of statins in a large cohort of HF patients.
Main Methods:
- Utilized the Hong Kong Clinical Data Analysis and Reporting System database (2004-2018) for patients with incident heart failure.
- Employed Inverse Probability of Treatment Weighting (IPTW) to balance covariates between statin users and non-users.
- Applied Cox proportional-hazard models with competing risk regression to assess dementia risk.
Main Results:
- Statin use was linked to a 20% reduced risk of all-cause dementia (SHR 0.80, 95% CI 0.76-0.84).
- Significant risk reductions were observed for Alzheimer's disease (28%), vascular dementia (18%), and unspecified dementia (20%).
- The study included 104,295 HF patients with a median follow-up of 9.9 years.
Conclusions:
- Statin therapy is associated with a significantly lower risk of dementia and its subtypes in patients with heart failure.
- Further randomized controlled trials and experimental studies are warranted to validate the neuroprotective role of statins.
Background:
Heart failure (HF) and dementia frequently co-exist with shared pathological mechanisms and risk factors. Our study aims to investigate the association between statin therapy and the risks of dementia and its subtypes among patients with HF.
Methods:
The Hong Kong Clinical Data Analysis and Reporting System database was interrogated to identify patients with incident HF diagnosis from 2004 to 2018, using ICD 9/ICD 10 codes. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between statin users (N = 54,004) and non-users (N = 50,291). The primary outcomes were incident all-cause dementia, including subtypes of Alzheimer's disease, vascular dementia, and unspecified dementia. Cox proportional-hazard model with competing risk regression was performed to estimate the sub-distribution hazards ratio (SHR) with corresponding 95% confidence intervals (CI) of the risks of all-cause dementia and its subtypes that are associated with statin use.
Findings:
Of all eligible patients with HF (N = 104,295), the mean age was 74.2 ± 13.6 years old and 52,511 (50.3%) were male. Over a median follow-up of 9.9 years (interquartile range [IQR]: 6.4-13.0), 10,031 (9.6%) patients were diagnosed with dementia, among which Alzheimer's disease (N = 2250), vascular dementia (N = 1831), and unspecified dementia (N = 5950) were quantified separately. After IPTW, statin use was associated with a 20% lower risk of incident dementia compared with non-use (multivariable-adjusted SHR 0.80, 95% CI 0.76-0.84). Stratified by subtypes of dementia, statin use was associated with a 28% lower risk of Alzheimer's disease (SHR 0.72, 95% CI 0.63-0.82), 18% lower risk of vascular dementia (SHR 0.82, 95% CI 0.70-0.95), and a 20% lower risk of unspecified dementia (SHR 0.80, 95% CI 0.75-0.85).
Interpretation:
In patients with HF, statin use was associated with a significantly lower risk of all-cause dementia and its subtypes, including Alzheimer's disease, vascular dementia, and unspecified dementia. Both randomized trials and experimental studies to validate the potential neuroprotective effect of statin are warranted.
Funding:
No funding was provided for this study.
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