他汀类药物使用与痴呆风险：一项系统综述和最新荟萃分析。

IF 4.9 Q1 CLINICAL NEUROLOGY Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2025-01-16 DOI:10.1002/trc2.70039

Fernando Luiz Westphal Filho, Paulo Roberto Moss Lopes, Artur Menegaz de Almeida, Vitor Kendi Tsuchiya Sano, Fernanda Moraes Tamashiro, Ocílio Ribeiro Gonçalves, Francisco Cezar Aquino de Moraes, Michele Kreuz, Francinny Alves Kelly, Pablo Vinícius Silveira Feitoza

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引用次数: 0

摘要

全球有5500万人患有痴呆症，预计到2050年这一数字将增加两倍。他汀类药物广泛用于治疗心血管疾病，也可能具有神经保护作用，尽管有关其对痴呆风险影响的研究显示出相互矛盾的结果。在本系统评价和荟萃分析中，我们按照系统评价和荟萃分析（PRISMA）指南的首选报告项目检索了PubMed、Embase和Cochrane。我们评估了痴呆、阿尔茨海默病（AD）和血管性痴呆（VaD）的风险，并根据性别、他汀类药物类型和糖尿病状况进行了亚组分析。共分析了55项观察性研究，包括700多万患者。与未使用他汀类药物的患者相比，使用他汀类药物可显著降低痴呆风险(风险比[HR] 0.86；95%置信区间[CI]: 0.82 ~ 0.91；p p p = 0.093)。亚组分析显示，2型糖尿病患者痴呆风险显著降低(HR 0.87；95% CI: 0.85 ~ 0.89；亮点：迄今为止最大的关于他汀类药物与痴呆风险的荟萃分析，包括55项研究和700多万患者。他汀类药物的使用与全痴呆、AD和VaD的风险降低有关。许多重要的亚组结果突出了他汀类药物不同的神经保护作用。研究结果支持他汀类药物作为公共卫生工具，特别是在低收入国家。未来的研究应该探索他汀类药物对不同患者群体的影响。

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Statin use and dementia risk: A systematic review and updated meta-analysis

Dementia affects 55 million people globally, with the number projected to triple by 2050. Statins, widely prescribed for cardiovascular benefits, may also have neuroprotective effects, although studies on their impact on dementia risk have shown contradictory results. In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed the risk of dementia, Alzheimer's disease (AD), and vascular dementia (VaD), with subgroup analyses by gender, statin type, and diabetes status. Fifty-five observational studies including over 7 million patients were analyzed. Statin use significantly reduced the risk of dementia compared to nonusers (hazard ratio [HR] 0.86; 95% confidence interval [CI]: 0.82 to 0.91; p < 0.001). It was also associated with reduced risks of AD (HR 0.82; 95% CI: 0.74 to 0.90; p < 0.001) and VaD (HR 0.89; 95% CI: 0.77 to 1.02; p = 0.093). Subgroup analyses revealed significant dementia risk reductions among patients with type 2 diabetes mellitus (HR 0.87; 95% CI: 0.85 to 0.89; p < 0.001), those with exposure to statins for more than 3 years (HR 0.37; 95% CI: 0.30 to 0.46; p < 0.001), and populations from Asia, where the greatest protective effect was observed (HR 0.84; 95% CI: 0.80 to 0.88). Additionally, rosuvastatin demonstrated the most pronounced protective effect for all-cause dementia among specific statins (HR 0.72; 95% CI: 0.60 to 0.88). Our findings underscore the neuroprotective potential of statins in dementia prevention. Despite the inherent limitations of observational studies, the large dataset and detailed subgroup analyses enhance the reliability of our results. Future randomized clinical trials are necessary to confirm these findings and enlighten clinical guidelines.

Highlights

Largest meta-analysis to date on statins and dementia risk, including 55 studies and more than 7 million patients.
Statin use linked to lower risks of all-dementia, AD, and VaD.
Numerous significant subgroup results highlight statins' diverse neuroprotective effects.
Findings support statins as a public health tool, especially in low-income countries.
Future research should explore the impact of statins across diverse patient populations.

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.