Statin therapy and risk of dementia in the elderly - A community-based prospective cohort study
Statin therapy and risk of dementia in the elderly - A community-based prospective cohort study
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DOI：
10.1212/01.wnl.0000142963.90204.58
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发表时间：
2004-11-09
期刊：
影响因子：
9.9
通讯作者：
Larson, EB
中科院分区：
文献类型：
--
作者：
Li, G;Higdon, R;Larson, EB
目的：在一项前瞻性队列研究中评估他汀类药物治疗与阿尔茨海默病（AD）风险之间的相关性，该研究记录了他汀类药物暴露和痴呆事件。方法：这是一项关于他汀类药物使用与痴呆和可能的AD发病率的前瞻性队列研究。从健康维护组织（HMO）中随机选择了2，356名年龄在65岁及以上的认知完整的人，每两年进行一次痴呆症评估。使用HMO药房数据库确定他汀类药物的使用。使用他汀类药物作为时间依赖性协变量的比例风险模型评估他汀类药物-痴呆/AD相关性。结果：在312例痴呆患者中，168例可能患有AD。他汀类药物使用的未校正风险比（HR）为1.33（95% CI 0.95至1.85），全因痴呆和0.90（CI 0.54至1.51）可能的AD。校正后的相应HR为1.19（CI 0.82 - 1.75）和0.82（CI 0.46 - 1.46）。在80岁之前进入研究的至少有一个APOE-ε 4等位基因的参与者的亚组分析产生的校正HR为0.33（CI 0.10至1.04）。结论：采用时间依赖性比例风险模型，作者发现他汀类药物的使用与痴呆或可能的AD之间没有显着关联。相反，当数据被不适当地作为病例对照研究进行分析时，作者发现可能的AD的OR为0.55，错误地表明他汀类药物的保护作用。研究设计和分析方法可以解释当前无效结果与早期结果之间的差异。
Objective: To assess the association between statin therapy and risk of Alzheimer disease ( AD) in a prospective cohort study with documented statin exposure and incident dementia. Methods: This is a prospective, cohort study of statin use and incident dementia and probable AD. A cohort of 2,356 cognitively intact persons, aged 65 and older, were randomly selected from a health maintenance organization (HMO), and were assessed biennially for dementia. Statin use was identified using the HMO pharmacy database. A proportional hazards model with statin use as a time-dependent covariate was used to assess the statin-dementia/AD association. Results: Among 312 participants with incident dementia, 168 had probable AD. The unadjusted hazard ratios (HRs) with statin use were 1.33 (95% CI 0.95 to 1.85) for all-cause dementia and 0.90 (CI 0.54 to 1.51) for probable AD. Adjusted corresponding HRs were 1.19 (CI 0.82 to 1.75) and 0.82 (CI 0.46 to 1.46). A subgroup analysis of participants with at least one APOE-epsilon4 allele who entered the study before age 80 produced an adjusted HR of 0.33 (CI 0.10 to 1.04). Conclusion: Employing time-dependent proportional hazards modeling, the authors found no significant association between statin use and incident dementia or probable AD. In contrast, when the data were analyzed, inappropriately, as a case-control study, the authors found an OR of 0.55 for probable AD, falsely indicating a protective effect of statins. Study design and analytic methods may explain the discrepancy between the current null findings and earlier findings.