Use of Statins and Risk of Dementia in Heart Failure: A Retrospective Cohort Study.

Abstract

Heart failure (HF) is associated with an increased risk of dementia, and studies show that dyslipidemia may be involved in the pathogenesis of dementia. However, it is unclear whether 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are associated with a lower risk of dementia in HF patients. The present study examines the effectiveness of statins to prevent dementia in HF patients. This retrospective longitudinal study used a cohort of patients with HF identified from a local US Medicare Advantage Prescription Drug plan to examine the incidence of dementia with up to 3 years of follow-up. A multivariable time-dependent Cox model and inverse-probability-of-treatment weighting (IPTW) of the marginal structural model were used to estimate the risk of developing dementia. Adjusted dementia rate ratios were estimated among current and former statin users, as compared with nonusers. The study included a total of 8062 HF patients (mean age 74.47 ± 9.21 years), of whom 1135 (14.08%) were diagnosed with dementia during a median follow-up of 22 months. Using the time-dependent Cox model, the adjusted dementia rate ratios among current and former users were 0.93 (95% confidence interval [CI] 0.71-1.21) and 0.99 (95% CI 0.79-1.25), respectively. Use of IPTW resulted in similar findings of 1.24 (95% conservative CI 0.89-1.72) among current users and 0.94 (95% conservative CI 0.67-1.31) among former users as compared with nonusers. This study found no difference in the risk of dementia among current and former users of statins as compared with nonusers in an already at-risk HF population.