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Age Related Memory Impairment

Statins may prevent Alzheimer's disease
By (Reuters Health)By Jill Stein
Apr 21, 2002, 4:05pm

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DENVER (Reuters Health) - Statin medications may reduce the risk of Alzheimer's disease, investigators told an audience at the 54th Scientific Session of the American Academy of Neurology (AAN) on Tuesday.

Dr. Robert C. Green and associates at Boston University School of Medicine conducted a case-control study of 2,581 subjects, 614 of whom were African-American. Data were obtained using standardized, validated questionnaires. Participants included 912 persons with probable or definite AD and 1,669 family members without dementia.

While two earlier observational studies had suggested that statins helped protect against AD, the results were limited by shortcomings in the trials' methodology, Dr. Green said. For example, in both of the studies, cases and non-cases were classified in non-standardized fashion by clinicians in practice and the temporal relationship between statin use and the onset of dementia symptoms was not clear, he said. Also, the earlier studies did not enroll African Americans, control for educational background nor assess the effect of APOE genotype.

In Dr. Green's Multi-Institutional Research in Alzheimer's Genetic Epidemiology (MIRAGE) Study, the relationship between statin use and the subsequent development of AD was examined using generalized estimating equations, adjusting for age, sex, ethnic background, education, history of heart disease, stroke, diabetes and APOE genotype.

Statin use was associated with a reduced risk of AD (adjusted OR=0.21).

Treatment with anti-hypercholesterolemic medications other than statins was not significantly associated with a decrease in AD risk. APOE genotype did not change the association between the risk of AD and statin use.

"The observed association between AD risk and statin use does not prove causality, and we can't say without a prospective clinical trial that statins actually protect against AD," Dr. Green told Reuters Health. "However, our study does bolster earlier reports suggesting that such a relationship exists, and, in addition, provides compelling evidence that a prospective clinical trial should be undertaken."

Also, while the study did not look at mechanisms that might explain the favorable effect of statins on AD risk, there are several possibilities, he said. For example, statins may exert their effectiveness via their cholesterol-lowering properties or by means of a global reduction in micro-infarct. Statins may also influence amyloid precursor protein (APP) production.

Finally, Dr. Green emphasized that the study is "particularly notable" in that it is the largest trial to show a protective effect of statin medications against AD as well as the first investigation to evaluate the effects of African-American ethnicity and APOE genotype.

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