Statins and Cognition: A Systematic Review and Meta-analysis of Short- and Long-term Cognitive Effects
Statins and Cognition: A Systematic Review and Meta-analysis of Short- and Long-term Cognitive Effects
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DOI：
10.1016/j.mayocp.2013.07.013
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发表时间：
2013-11-01
影响因子：
8.9
通讯作者：
Martin, Seth S.
中科院分区：
文献类型：
--
作者：
Swiger, Kristopher J.;Manalac, Raoul J.;Martin, Seth S.
目的：评价他汀类药物对痴呆患者短期认知功能和长期痴呆发生率的影响。应用他汀类药物治疗的无认知功能障碍的成人纳入高质量的随机对照试验和前瞻性队列研究。结果：16篇研究纳入定性合成，11篇纳入定量合成。短期试验没有显示他汀类药物对认知终点的一致效果。数字符号替代测试(一种有效的认知功能测量)是最常见的短期终点，他汀组和安慰剂组从基线到随访的平均变化没有显著差异(平均变化，1.65；95%可信区间，-0.03到3.32；在3个试验中总暴露296次)。长期认知研究包括23443名患者，平均暴露时间为3至24.9年。三项研究发现他汀类药物的使用与痴呆症的发生没有关联，五项研究发现了有利的效果。合并结果显示，他汀类药物治疗的患者痴呆发生率降低29%(风险比0.71；95%可信区间0.61-0.82)。结论：在没有基线认知功能障碍的患者中，短期数据最符合他汀类药物对认知的不良影响，长期数据可能支持他汀类药物在预防痴呆方面的有益作用。(C)2013年梅奥医学教育和研究基金会
Objective: To evaluate the effect of statins on short-term cognitive function and the long-term incidence of dementia.Patients and Methods: A systematic search was performed of MEDLINE, EMBASE, and the Cochrane Central Register from their inception to April 25, 2013. Adults with no history of cognitive dysfunction treated with statins were included from high-quality randomized controlled trials and prospective cohort studies after formal bias assessment.Results: Sixteen studies were included in qualitative synthesis and 11 in quantitative synthesis. Shortterm trials did not show a consistent effect of statin therapy on cognitive end points. Digit Symbol Substitution Testing (a well-validated measure of cognitive function) was the most common short-term end point, with no significant differences in the mean change from baseline to follow-up between the statin and placebo groups (mean change, 1.65; 95% CI, -0.03 to 3.32; 296 total exposures in 3 trials). Long-term cognition studies included 23,443 patients with a mean exposure duration of 3 to 24.9 years. Three studies found no association between statin use and incident dementia, and 5 found a favorable effect. Pooled results revealed a 29% reduction in incident dementia in statin-treated patients (hazard ratio, 0.71; 95% CI, 0.61-0.82).Conclusion: In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia. (C) 2013 Mayo Foundation for Medical Education and Research