Statins reduce mortality even in dementia

Berlin, Germany – New research published in Neurology shows that statin use is associated with reduced mortality among older people living in nursing homes, regardless of their dementia status.

The study is one of the first to examine whether statin use among older people living in nursing homes reduces mortality, particularly in people with dementia, a group largely excluded from previous statin studies.

An analysis of four years of data from nearly 300,000 nursing home residents found that statin use was associated with a 40% lower risk of all-cause mortality than not using statins in people without dementia and a 20% lower risk in people without dementia. . people with dementia.

“These results may provide evidence for continued use of statins in older nursing home patients with multiple medical conditions,” wrote lead author Dr. Dr Julie Lorraine O’SullivanCharité, Faculty of Medicine of the Free University of Berlin (Universitatsmedizin Berlin, Freie Universität Berlin) and the German Mental Health Center (Berlin, Germany) and colleagues.

Poorly studied population

Statins are first-line drugs for the prevention of atherosclerotic cardiovascular disease, but we know they carry risks for frail or dependent patients. Many previous clinical studies excluded older participants with multiple comorbidities, especially dementia. Therefore, evidence of drug effectiveness in this population was lacking.

The researchers retrospectively examined 5 years of German insurer and long-term care provider claims data from 282,693 nursing home residents (mean age 83 years) who had been consistently taking statins for ≥6 months.

The researchers used propensity score matching on 96,162 individuals to adjust for potential imbalances in the distribution of covariates (eg, age, gender, atrial fibrillation, cardiovascular disease and other conditions, and medications) and reduce bias. Cox regression models were similarly adjusted for these factors as well as level of care. Residents were followed for an average of 2 years.

There were 54,269 deaths recorded during the study period, with the majority of patients requiring a high level of care and 65% suffering from dementia.

Statin use was associated with a reduction in all-cause mortality in patients with dementia (hazard ratio [RR] 0.80; p < 0.001) and in those without dementia (RR 0.73; p < 0.001) compared with nonusers. The benefits remained consistent even after excluding participants with a history of cardiovascular disease and in subgroups stratified by age, sex, level of care, and type of dementia.

Limitations of the study include the possibility of unknown confounding factors and lack of information on previous statin use, smoking and physical inactivity, and causes of mortality.

“Although our results suggest benefits of statins, it is critical to recognize the need for further research to understand the underlying mechanism and the need to replicate our results to understand the potential risks before making recommendations to physicians and patients and their families regarding statin treatment,” said He. the researchers wrote.

” The initial stage “

In an editorial accompanying the study, Dr. Ariela OrkabiAssociate Professor of Medicine, Brigham and Women’s Hospital, Harvard Medical School (Harvard Medical School – Boston, USA), called the study a “first step” towards better understanding statin use in an understudied population.

“These results are based on a limited set of observational data regarding statin use in high-risk older adults, which generally demonstrated a protective association between statins and mortality, including in people with dementia and frailty, although nursing home status was not specifically studied,” wrote Professor Orkaby.

It may be more important to obtain information about the effect of statins on mortality risk in older people with dementia than to better understand how these drugs can improve quality of life by reducing the risk of accidents, stroke, or other cardiovascular events.

“It may be time to reconsider general recommendations to avoid or “deprescribe” statins in nursing home residents and instead invest in high-quality evidence to guide care for this vulnerable population. “At the end of the day, lack of evidence does not mean there is an advantage or disadvantage, but rather that more data is needed,” added Professor Orkabi.

Funding and connections by interest

The study was funded by Stiftung Charite; Dr. O’Sullivan et al reported no relevant financial relationships. Professor Orkady received a VA CSR&D CDA-2 grant.

This article was translated from Medscape.com using several editorial tools, including artificial intelligence. Before publication, the material was checked by the editors.