Lipid-lowering therapy and the risk of dementia: lessons learned from two decades of controversy

[Eddy Edson]

A brief nuanced review just published in the European Heart Journal:

Lipid-lowering therapy and the risk of dementia: lessons learned from two decades of controversy

Lipid-lowering agents constitute a cornerstone of cardiovascular disease (CVD) prevention. As such, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (

academic.oup.com

In conclusion, contemporary evidence tends to support the notion that lipid-lowering therapy with statins does not significantly alter cognitive function in medium-term studies. Long-term studies (≥10 years of follow-up) are currently pending, however, their implementation is of paramount importance. One of the key challenges in observational studies constitutes the potential of an indication bias, which can be partly addressed by controlling for known risk factors and markers of a healthy lifestyle. Other important issues include the capability of different statins to penetrate the blood-brain barrier based on their lipophilicity, as well as the selection of an optimal dose (low-dose vs. high-dose statin therapy). The latter remains a subject of debate and requires further investigation. Finally, a careful stratification approach to predict the underlying CVD risk in elderly patients is critical, given that cardiovascular benefits of lipid-lowering therapy clearly outweigh the risks associated with potential short-term cognitive detriment. Along this line, advanced imaging tools may help identify patients at risk and guide appropriate preventive strategies, particularly if concerns of statin-associated cognitive detriment are substantiated. While evidence to date remains controversial, the vast amount of available data facilitates the planning of future studies that should aim at better delineating the link between lipid-lowering therapy and neurocognitive function.

 

[nonethewiser]

Gonna guess that 10 year study will say same, if so will put lot of nonsense going around to bed.

 

[Eddy Edson]

Gonna guess that 10 year study will say same, if so will put lot of nonsense going around to bed.

Hope so, but if you believe that statins are part of a vast conspiracy between big pharma, researchers and doctors then you're probably not going to be very sensitive to quality of evidence. There'll always be grifting charlatans on the fringes of the medical world supplying enough contrary "evidence" to help keep the belief system intact.

 

[nonethewiser]

Hope so, but if you believe that statins are part of a vast conspiracy between big pharma, researchers and doctors then you're probably not going to be very sensitive to quality of evidence. There'll always be grifting charlatans on the fringes of the medical world supplying enough contrary "evidence" to help keep the belief system intact.

Unfortunately they'll always be gullible people who believe these quacks & conspiracy theorists, such is life my friend.

 

[Drummer]

Nothing will ever convince me to take a statin again. If the alternative is to die then I will die - nothing will ever make me take something which made my body deny me mobility, unable to recall the songs I have collected over a lifetime or send me wandering around a supermarket carpark unable to find the car with a trolley full of unnecessary shopping.
My brain, my memories, my body, my life, my choice.

 

[bulkbiker]

Unfortunately they'll always be gullible people who believe these quacks & conspiracy theorists, such is life my friend.

" contemporary evidence tends to support the notion that lipid-lowering therapy with statins does not significantly alter cognitive function in medium-term studies. Long-term studies (≥10 years of follow-up) are currently pending, however, their implementation is of paramount importance."

'Tends to support the notion.'.. hardly strong evidence?

maybe the "quacks and conspiracy theorists" might have a point?

 

[trophywench]

Drummer and I both have the utterly prime evidence of our brains obliterating important things for no apparent logical reason, to tell us that statins affected them. That's enough for her and enough for me. I have PAD now anyway so that will most likely kill me, whenever, I expect. So I have accepted that, like her, cos we're both sensible and therefore both know we will die (of something) eventually anyway. Simply one of the hazards of being born!

Meanwhile we'll carry on enjoying those parts of our lives we can still enjoy, thanks.

 

[Deleted member 21371]

Drummer and I both have the utterly prime evidence of our brains obliterating important things for no apparent logical reason, to tell us that statins affected them. That's enough for her and enough for me. I have PAD now anyway so that will most likely kill me, whenever, I expect. So I have accepted that, like her, cos we're both sensible and therefore both know we will die (of something) eventually anyway. Simply one of the hazards of being born!

Meanwhile we'll carry on enjoying those parts of our lives we can still enjoy, thanks.

On the flip side, there is an association between PAD and vascular cognitive impairment.

 

[Windy]

As my former statistics lecturer once said, "correlation is not causation".

Whatever we may personally feel or believe about the greatness or otherwise of statins, they have been proven in multiple studies to give benefit to some people. They have also been proven to have side effects to other people (as do every other medication, as far as I know - eg if you take metformin, it can give about 10% of people a powerfully runny tummy, and aspirin can give stomach bleeds).

Whilst Trophywench and Drummer have both have bad experiences of the side effects, and that was dreadful for them both, I know people who have taken them without any problems at all. I started taking statins and kept my fingers crossed that I don't have side effects.
I guess what I take is that there's enough genetic variability in the population for some medications to be fine for some people and not at all fine for others. There's both a benefit and a risk of side effects when you take them, as there is with anything else you do; if I go out the house, there's a small risk I might be run over when I cross the road, but the risk is minimal and the benefits outweigh that because I get a nice walk. I deem the risk ok for me to take, and with statins too.

 

[nonethewiser]

As my former statistics lecturer once said, "correlation is not causation".

Whatever we may personally feel or believe about the greatness or otherwise of statins, they have been proven in multiple studies to give benefit to some people. They have also been proven to have side effects to other people (as do every other medication, as far as I know - eg if you take metformin, it can give about 10% of people a powerfully runny tummy, and aspirin can give stomach bleeds).

Whilst Trophywench and Drummer have both have bad experiences of the side effects, and that was dreadful for them both, I know people who have taken them without any problems at all. I started taking statins and kept my fingers crossed that I don't have side effects.
I guess what I take is that there's enough genetic variability in the population for some medications to be fine for some people and not at all fine for others. There's both a benefit and a risk of side effects when you take them, as there is with anything else you do; if I go out the house, there's a small risk I might be run over when I cross the road, but the risk is minimal and the benefits outweigh that because I get a nice walk. I deem the risk ok for me to take, and with statins too.

Also, like everything in life your more likely to here stories of the negative nature than good.

Statins have been around a long time now & most be one of the most researched drugs around, from own reading medical opinion is they are very effective & perfectly safe for majority of population.

 

[trophywench]

The main negative thing that was evident on diabetes forums was muscle problems so I was gobsmacked and when this memory loss came to a head and there was no logical reason evident after I'd lost my job because of the consequences of it I just decided well damn everyone else - I need to know what the hell has caused this because I surely can't have dementia, can I?? - so best try stopping whatever I can stop that I don't actually desperately need for life itself then, I think.
At the time I'd been T1 doing well on various insulins for 30 years - so I didn't think it could be insulin - in fact I really didn't want to think about that possibility thanks. The only other two possibilities were either of the two things I'd been prescribed in the past, 'Purely for protective purposes since you have diabetes'. They were Losartan for BP and Simvastatin (originally Ator~ but then changed to Sim~ cos it was cheaper) for chol, both of which I took before bed. So which one to try dropping first? Who knows, but anyway I opted to miss the statin and I'd try without it for a month and then 'see' what happened ......

From there I saw myself - and my husband commented - improvements within 10-14 days which continued but it took me personally a much longer time to get over it and the bloody insult of it making me unemployable* so losing income and hence also investment for our retirement.

* Because I freely admit working solely in the insurance industry which as years ago a friend who ran an employment agency commented 'which you'd just intended to do between leaving school and retiring'. Well yeah, indeed!

I knew most things about a) underwriting UK liability insurance and b) arranging all classes of insurance worldwide for large international companies - not exactly transferable skills! Plus aged 58, no sensible company would really want to spend a penny training me to do something else, when I'm adamant I'm going to retire anyway aged 60. 44 years constantly employed is enough thanks.

 

[Eddy Edson]

The main negative thing that was evident on diabetes forums was muscle problems so I was gobsmacked and when this memory loss came to a head and there was no logical reason evident after I'd lost my job because of the consequences of it I just decided well damn everyone else - I need to know what the hell has caused this because I surely can't have dementia, can I?? - so best try stopping whatever I can stop that I don't actually desperately need for life itself then, I think.
At the time I'd been T1 doing well on various insulins for 30 years - so I didn't think it could be insulin - in fact I really didn't want to think about that possibility thanks. The only other two possibilities were either of the two things I'd been prescribed in the past, 'Purely for protective purposes since you have diabetes'. They were Losartan for BP and Simvastatin (originally Ator~ but then changed to Sim~ cos it was cheaper) for chol, both of which I took before bed. So which one to try dropping first? Who knows, but anyway I opted to miss the statin and I'd try without it for a month and then 'see' what happened ......

From there I saw myself - and my husband commented - improvements within 10-14 days which continued but it took me personally a much longer time to get over it and the bloody insult of it making me unemployable* so losing income and hence also investment for our retirement.

* Because I freely admit working solely in the insurance industry which as years ago a friend who ran an employment agency commented 'which you'd just intended to do between leaving school and retiring'. Well yeah, indeed!

I knew most things about a) underwriting UK liability insurance and b) arranging all classes of insurance worldwide for large international companies - not exactly transferable skills! Plus aged 58, no sensible company would really want to spend a penny training me to do something else, when I'm adamant I'm going to retire anyway aged 60. 44 years constantly employed is enough thanks.

No move from yr doc to try another lipid med?

 

[Deleted member 21371]

Drummer and I both have the utterly prime evidence of our brains obliterating important things for no apparent logical reason, to tell us that statins affected them. That's enough for her and enough for me. I have PAD now anyway so that will most likely kill me, whenever, I expect. So I have accepted that, like her, cos we're both sensible and therefore both know we will die (of something) eventually anyway. Simply one of the hazards of being born!

Meanwhile we'll carry on enjoying those parts of our lives we can still enjoy, thanks.

A build of plaque due to high cholesterol is unlikely to kill you.
Most likely it'll just be a life changing event such as a heart attack, stroke, PAD, or similar.

 

[trophywench]

No move from yr doc to try another lipid med?

Only ever statins - once years ago the D consultant wrote to him with latest chol test results and said you may like to discuss adding a fibrate which Mrs C is open to - but he obviously didn't like that suggestion since he never wanted to talk to me about em or ezetimibe when I specifically asked 'What about them then?', he just shook his head and immediately changed the subject.

Since taking any type of statin terrifies me, which yes HCPs still ask me why I'm not taking one, I don't mention it myself. My GP record also says I'm allergic to a specific AB - and I have absolutely no idea whatsoever about that cos I don't remember either having it prescribed or being allergic to it. It's dated 1998, which is when I registered with them when I first moved here. I haven't ever had that much wrong with me really, ever, to warrant ABs very often, so you'd think I'd remember being allergic to one. I really ought to ask them, I know, but since I found this on my record (pre dates Covid) I have always thought it was ridiculous wasting a doctors appt for that when there are ill people.

 

[Eddy Edson]

Only ever statins - once years ago the D consultant wrote to him with latest chol test results and said you may like to discuss adding a fibrate which Mrs C is open to - but he obviously didn't like that suggestion since he never wanted to talk to me about em or ezetimibe when I specifically asked 'What about them then?', he just shook his head and immediately changed the subject.

Frikkn ridiculous PAD treatment is so woefully underdone. The guidelines demand aggressive treatment for PAD, and that means one of the alternative meds if you're statin-intolerant. I feel like giving yr doc's nose a tweak!

 

[trophywench]

We used to walk a lot, all in all, well beyond the time when my PAD was diagnosed, and at that time it got checked up on regularly 4 times a year anyway at an OP clinic at a nearby hospital - but they stopped holding the clinic, hence nobody has even asked me about it since. Same as nobody asks anything now about my emphysema also diagnosed nearly 20 years ago.

Been a complete waste of time chasing the GP surgery for such things since 2020 basically. These things used to be predictably regular, so you never had to chase for them. Now it seems to me UNLESS you absolutely keep records yourself of when things should happen - nothing will. But - this is not at all how the NHS used to work - and so far nobody whatsoever has actually informed us properly that it no longer does - so we're clueless as to whether it's 'just our lot' or everyone else is in the same boat.

 

[Deleted member 21371]

Frikkn ridiculous PAD treatment is so woefully underdone. The guidelines demand aggressive treatment for PAD, and that means one of the alternative meds if you're statin-intolerant. I feel like giving yr doc's nose a tweak!

My docs are brilliant.
I don't get away with anything.
I haven't got PAD, but they would be on my back if I had

 

[Eddy Edson]

My docs are brilliant.
I don't get away with anything.
I haven't got PAD, but they would be on my back if I had

You're lucky! I had to badger mine into following guidelines. If I'd had CAD rather than PAD it would have been different, even tho PAD is at just as serious.

 

[Deleted member 21371]

You're lucky! I had to badger mine into following guidelines. If I'd had CAD rather than PAD it would have been different, even tho PAD is at just as serious.

My surgery is very aggressively friendly.