Statins and risks of dementia among patients with heart failure: a population-based retrospective cohort study in Hong Kong

Qing-Wen Ren; Tiew-Hwa Katherine Teng; Yi-Kei Tse; Christopher Tze Wei Tsang; Si-Yeung Yu; Mei-Zhen Wu; Xin-Li Li; Denise Hung; Hung-Fat Tse; Carolyn S P Lam; Kai-Hang Yiu

doi:10.1016/j.lanwpc.2023.101006

Statins and risks of dementia among patients with heart failure: a population-based retrospective cohort study in Hong Kong

Lancet Reg Health West Pac. 2024 Jan 17:44:101006. doi: 10.1016/j.lanwpc.2023.101006. eCollection 2024 Mar.

Authors

Qing-Wen Ren^{1

2}, Tiew-Hwa Katherine Teng^{3

4

5}, Yi-Kei Tse², Christopher Tze Wei Tsang², Si-Yeung Yu², Mei-Zhen Wu^{1

2}, Xin-Li Li⁶, Denise Hung², Hung-Fat Tse^{1

2}, Carolyn S P Lam^{3

4

7}, Kai-Hang Yiu^{1

2}

Affiliations

¹ Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
² Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
³ National Heart Center Singapore, Singapore.
⁴ Duke-NUS Medical School, Singapore.
⁵ School of Allied Health, University of Western Australia, Australia.
⁶ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁷ Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Background: Heart failure (HF) and dementia frequently co-exist with shared pathological mechanisms and risk factors. Our study aims to investigate the association between statin therapy and the risks of dementia and its subtypes among patients with HF.

Methods: The Hong Kong Clinical Data Analysis and Reporting System database was interrogated to identify patients with incident HF diagnosis from 2004 to 2018, using ICD 9/ICD 10 codes. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between statin users (N = 54,004) and non-users (N = 50,291). The primary outcomes were incident all-cause dementia, including subtypes of Alzheimer's disease, vascular dementia, and unspecified dementia. Cox proportional-hazard model with competing risk regression was performed to estimate the sub-distribution hazards ratio (SHR) with corresponding 95% confidence intervals (CI) of the risks of all-cause dementia and its subtypes that are associated with statin use.

Findings: Of all eligible patients with HF (N = 104,295), the mean age was 74.2 ± 13.6 years old and 52,511 (50.3%) were male. Over a median follow-up of 9.9 years (interquartile range [IQR]: 6.4-13.0), 10,031 (9.6%) patients were diagnosed with dementia, among which Alzheimer's disease (N = 2250), vascular dementia (N = 1831), and unspecified dementia (N = 5950) were quantified separately. After IPTW, statin use was associated with a 20% lower risk of incident dementia compared with non-use (multivariable-adjusted SHR 0.80, 95% CI 0.76-0.84). Stratified by subtypes of dementia, statin use was associated with a 28% lower risk of Alzheimer's disease (SHR 0.72, 95% CI 0.63-0.82), 18% lower risk of vascular dementia (SHR 0.82, 95% CI 0.70-0.95), and a 20% lower risk of unspecified dementia (SHR 0.80, 95% CI 0.75-0.85).

Interpretation: In patients with HF, statin use was associated with a significantly lower risk of all-cause dementia and its subtypes, including Alzheimer's disease, vascular dementia, and unspecified dementia. Both randomized trials and experimental studies to validate the potential neuroprotective effect of statin are warranted.

Funding: No funding was provided for this study.

Keywords: Cognitive impairment; Dementia; Heart failure; Statin.