The
University of Kentucky Public Relations & Strategic Communications
Office provides a weekly health column available for use and reprint by
news media. This week’s column is by Larry Goldstein, M.D., chair of the University of Kentucky’s Department of Neurology, co-director of the Kentucky Neuroscience Institute and interim medical director of the UK HealthCare/Norton Healthcare – Stroke Care Network.
LEXINGTON, Ky. (June 24, 2024) – Statins, drugs
often used in the treatment of patients with or at higher risk of
atherosclerotic cardiovascular disease, do not put people at an
increased risk of neurological complications, the American Heart Association (AHA) said in a recently issued scientific statement.
A committee I have the privilege of chairing recently wrote the AHA
statement, which is connected to a core function of statins: reducing
low-density lipoprotein cholesterol (LDL-C). High levels of LDL-C are
associated with atherosclerosis, or the thickening and hardening of the
arteries. This can lead to heart attack, stroke, blood clots and other complications affecting the cardiovascular system.
We know that statins and other medications to lower cholesterol
levels have a dramatic impact in reducing the risk for cardiovascular
disease in general, but cardiac disease and stroke in particular.
However, these medications aren’t prescribed as frequently as they could
be, in part, because of concern about potential side effects. There
isn’t any credible evidence that lipid lowering with statins or other
medications increases the risk of developing Alzheimer’s disease or
major cognitive impairment which have been public concerns.
Some older studies suggested that statins and the lowering of LDL-C
might be associated with cognitive impairment or dementia. According to
the AHA, “the preponderance of observational studies and data from
randomized trials do not support this conclusion.” Additionally, there
is no evidence that the use of statins and other lipid lowering
medications worsens the symptoms of patients already diagnosed with
Alzheimer’s disease, dementia or other cognitive impairments.
The AHA statement also notes the risk of a hemorrhagic stroke in
patients with no cerebrovascular disease is “small and consistently
nonsignificant.” A hemorrhagic stroke is caused by the rupture of a
blood vessel in or on the brain; they are responsible for about 13 percent of stroke cases.
In primary prevention, folks who haven’t had a stroke or myocardial
infarction (heart attack), but are at risk because of high lipid level
or other factors, there is virtually no evidence that lowering lipid
levels — even to very low levels — increases the risk of brain
hemorrhage.
What does this mean?
- Patients who use a statin or other drug to lower LDL-C are not at
increased risk of developing Alzheimer’s disease or other major
cognitive impairment. - Patients who use a statin or other drug to lower LDL-C, and have
not suffered a stroke or heart attack, are not at increased risk of
hemorrhagic stroke. - Patients living with Alzheimer’s disease or another form of
cognitive impairment are not at increased risk of worsening symptoms if
they also use a statin or other drug to lower LDC-C. - There is a significant number of patients who could benefit from
statins and other lipid-lowering drugs who do not currently use them.
The benefit in reducing stroke, myocardial infarction and vascular
events well outweigh even the small, theoretic risk. The gap between the
use of these medications and the potential benefit is pretty wide.
There is a large population of patients who could benefit who are not
taking advantage of these medications or of this treatment approach. As
always, patients should discuss the potential benefits and risks of any
treatment with their health care provider.
If you would like to learn more, click here to watch a video about the statement.
