Statin Use and All-Cause Mortality in Patients With Dementia: What’s the Link?

Statin therapy reduced all-cause mortality among nursing home residents both with and without dementia, according to study results published in Neurology.

Researchers conducted a retrospective cohort study to determine the role of statin use in all-cause mortality in nursing home residents with and without a diagnosis of dementia.

Claims data on German nursing home residents aged 60 and older were collected between January 2015 and December 2019 from a health and long-term care insurance fund. Demographic data and data pertaining to doctor visits, diagnostic codes, prescription medications, and long-term care levels (ranging from lowest care dependency, 1 to highest care dependency, 5) were extracted. Residents on statin therapy for at least 6 consecutive months were categorized as statin users, while those without consecutive statin prescriptions were classified as nonusers. Patients were categorized into 4 groups: statin nonuser with dementia (reference group), statin user with dementia, statin nonuser without dementia, or statin user without dementia. The association between statin use and all-cause mortality was evaluated using propensity score-based Cox proportional hazards models.

A total of 282,693 patients were included in the study, of which 96,162 (mean age, 82.91; women, 68.9%; care level 4, 31.8%; documented dementia, 64.9%) were matched. The average observation period was 2.25 years and 54,269 deaths were recorded.

Among statin nonusers with dementia and statin users with dementia there were 22,568 and 19,062 deaths, respectively. In statin nonusers without dementia and statin users without dementia there were 6076 and 6563 deaths, respectively.

Compared with statin nonusers, statin users with dementia had 20% lower all-cause mortality risk (hazard ratio [HR], 0.80; 95% CI, 0.78-0.82; P <.001). Statin users without dementia had 27% lower all-cause mortality (HR, 0.73; 95% CI, 0.71-0.76; P <.001) vs those with no reported statin use. Statin users without dementia had the lowest risk, while statin nonusers with dementia had the highest risk of all-cause dementia.

In separate subanalyses for history of atherosclerotic cardiovascular disease and history of hyperlipidemia, individuals with reported statin use and without dementia had the lowest risk, while those without reported statin use and with dementia had the highest risk for all-cause mortality.

Similarly, in the subanalyses for dementia type, individuals with reported statin use and without dementia had the lowest risk, while those without reported statin use and vascular dementia/Alzheimer disease had the highest risk for all-cause mortality.

In further subanalysis, when stratifying by age, similar trends were observed. Patients within the age groups of 60 to 79, 80 to 84, 85 to 89, or aged 90 and older who reported statin use without dementia had the lowest all-cause mortality risk. 

In subanalyses stratified by care dependency, patients without dementia and with statin use had the lowest all-cause mortality risk across all groups.

In sex-specific analysis, women and men with reported statin use without dementia had the lowest risk, while those without reported statin use and with dementia had the highest risk of all-cause mortality.

There was a significantly increased risk for all-cause mortality among low-intensity statin users (HR, 1.27; 95% CI, 1.18-1.36; P <.001) vs moderate-intensity statin users. However, there were no differences between moderate-intensity and high-intensity statin users in the context of all-cause mortality risk (HR, 1.06; 95% CI, 0.93-1.21; P =.38).

Study limitations included incomplete and missing data, the cohort design, and the inability to assess adverse effects and/or discontinuation of statins. “[I]t is vital to acknowledge the need for further research to understand the underlying mechanism, and the need for replication of our results to understand the potential risks before making recommendations to clinicians and families regarding statin therapy,” the researchers concluded.