HEART
November 22, 2013

Good News on Statins

A review of these cholesterol-lowering drugs finds they do not contribute to mental decline.

If you are among the 30 million Americans taking a statin to lower your cholesterol, you have probably been paying attention to the news lately. One message is clear: statins' ability to lower cholesterol remains a valuable tool for preventing heart attacks.

Last week, however, the American Heart Association and the American College of Cardiology released a new set of guidelines for reducing cholesterol levels, saying that many more people may benefit from statin therapy to lower cholesterol and the risk of heart attack. But then a group from Harvard called the calculations that were the basis for the guidelines into question.

I thought that in the course of conducting this review, that there might be a red flag, but we did not see one.

So it was reassuring when University of Pennsylvania researchers published what they say is the largest comprehensive review of statin therapy so far, finding that it does not appear to contribute to the memory loss or dementia that characterize cognitive decline.

There had been a growing concern that statins were associated with memory problems and other mental impairments. According to Emil deGoma, author on the study, “I think it really rose to the fore in February 2012 when the FDA included in a drug safety communication that statins may be associated with memory loss and other forms of cognitive impairment.”

The Penn team’s analysis had three components. First they reviewed existing studies on the association between statins and longer-term cognitive outcomes such as Alzheimer’s disease, dementia, and mild cognitive impairment. Another looked at studies that examined the association between statins and cognitive performance scores.

A third aspect of the study analyzed the FDA’s adverse event reporting database and the frequency of cognitive adverse events that were reported in that database.

“In each of these three analyses, we did not find any significant association between statin use and memory loss or other forms of cognitive impairment, which I think is quite reassuring, ” deGoma, an assistant professor of medicine and medical director of the preventive cardiovascular program at the Perelman School of Medicine at the University of Pennsylvania, said.

deGoma was surprised by the consistency of the available data, “I thought that in the course of conducting this review, that there might be a red flag, but we did not see one.” Further studies, especially large, randomized trials that look at the effect of higher doses of statins on cognitive function are still needed however.

The new AHA and ACC guidelines mean that many more people would be urged to start statin therapy to control cholesterol, by some estimates millions, “So I do think in that case, it becomes even more important to assess the potential side effects of these medications,” deGoma said.

Talk to Your Doctor
As with any medication, the dialog between patients and their doctors should be about the risks and benefits of starting the medication. In the case of statins, that conversation starts with a comprehensive assessment of a person’s risk of having a heart attack or stroke. If someone is at risk for heart attack or stroke, the benefits of statins far outweigh any risks involved.

According to deGoma, “If a patient is at high risk for heart attack and stroke, and would benefit from statin therapy, I would not let concerns of hypothetical cognitive impairment stop me from using a medication that has been proven effective.”

The Penn study is published in the Annals of Internal Medicine.

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