Statins and the risk of dementia
Statins and the risk of dementia
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DOI：
10.1016/s0140-6736(00)03155-x
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发表时间：
2000-11-11
期刊：
影响因子：
168.9
通讯作者：
Drachman, DA
中科院分区：
文献类型：
--
作者：
Jick, H;Zornberg, GL;Drachman, DA
背景痴呆症影响估计10%的65岁以上的人口。由于血管和脂质相关机制被认为在阿尔茨海默病和血管性痴呆的发病机制中起作用，我们对HMGCoA的潜在作用进行了流行病学研究（3-羟基-3-甲基戊二酰-辅酶A）还原酶抑制剂（他汀类）和其他降脂剂对痴呆的作用，方法：我们采用嵌套病例对照设计，信息来自368个实践，有助于英国的全科医学研究数据库。基础研究人群包括三组年龄在50岁及以上的患者：所有接受过降脂药（LLAs）的患者;所有临床诊断为未经治疗的胆固醇血症的患者;以及随机选择的一组其他患者。从这个基础人群中，确定了所有计算机记录的痴呆症临床诊断病例。每个病例匹配多达四个控制来自基础人口的年龄，性别，实践，和索引日期的case.Findings-该研究包括284例痴呆症和1 080控制。在对照组中，13%的患者未经治疗，11%的患者服用他汀类药物，7%的患者服用其他LLA，69%的患者没有接受过他汀类药物或LLA暴露。痴呆的相对危险度估计值经猿类、性别、冠状动脉疾病史、高血压、冠状动脉搭桥手术和脑缺血、吸烟和体重指数校正后，（比值比0.72 [95% CI 0.45-1.14]），或接受非他汀类LLA治疗（0.96 [0.47-1.97]，接近1.0，与未诊断为胆固醇血症或未接触其他降脂药物的人相比不显著。那些处方他汀类药物的校正相对风险为0.29（0.13-0.63; p=0.002）。解释50岁及以上的处方他汀类药物的个体发生痴呆的风险显著降低，与是否存在未治疗的痴呆症或暴露于非他汀类LLA无关。现有的数据没有区分阿尔茨海默病和其他形式的痴呆症。
Background Dementia affects an estimated 10% of the population older than 65 years. Because vascular and lipid-related mechanisms are thought to have a role in the pathogenesis of Alzheimer's disease and vascular dementia, we did an epidemiological study of the potential effect of HMGCoA (3 hydroxy-3 methylglutaryl-coenzyme A) reductase inhibitors (statins) and other lipid-lowering agents on dementia,Methods We used a nested case-control design with information derived from 368 practices which contribute to the UK-based General Practice Research Database. The base study population included three groups of patients age 50 years and older: all individuals who had received lipid-lowering agents (LLAs); all individuals with a clinical diagnosis of untreated hyperlipidaemia: and a randomly selected group of other individuals. From this base population, all cases with a computer-recorded clinical diagnosis of dementia were identified. Each case was matched with up to four controls derived from the base population on age, sex, practice, and index date of case.Findings The study encompassed 284 cases with dementia and 1 080 controls. Among controls 13% had untreated hyperlipidaemia, 11% were prescribed statins, 7% other LLAs, and 69% had no hyperlipidaemia or LLA exposure. The relative risk estimates of dementia adjusted for ape, sex, history of coronary-artery disease, hypertension, coronary-bypass surgery and cerebral ischaemia, smoking and body mass index for individuals with untreated hyperlipidaemia (odds ratio 0.72 [95% CI 0.45-1.14]), or treated with non-statin LLAs (0.96 [0.47-1.97], was close to 1.0 and not significant compared with people who had no diagnosis of hyperlipidaemia or exposure to other lipid-lowering drugs. The adjusted relative risk for those prescribed statins was 0.29 (0.13-0.63; p=0.002).Interpretation Individuals of 50 years and older who were prescribed statins had a substantially lowered risk of developing dementia, independent of the presence or absence of untreated hyperlipidaemia, or exposure to non-statin LLAs. The available data do not distinguish between Alzheimer's disease and other forms of dementia.