Karl Richardson, MD (*); Marisa Schoen, BA (*); Benjamin French, PhD; Craig A. Umscheid, MD, MSCE; Matthew D. Mitchell, PhD; Steven E. Arnold, MD; Paul A. Heidenreich, MD, MS; Daniel J. Rader, MD; Emil M. deGoma, MD
Potential Conflicts of Interest: Dr. Arnold: Board membership fees: TEVA Pharmaceuticals; Grants: National Institutes of Health, Pfizer, Bristol Myers Squibb, Johnson and Johnson, Merck. Dr. Rader: Personal fees: AstraZeneca, Pfizer, Merck. Dr. deGoma: Personal fees: Aegerion; Grants: Pfizer, Amgen, Novartis, Regenerol. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3027.
Requests for Single Reprints: Emil M. deGoma, MD, Perelman Center for Advanced Medicine, Heart and Vascular Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104; e-mail, Emil.deGoma@uphs.upenn.edu.
Current Author Addresses: Dr. Richardson, Ms. Schoen, and Dr. deGoma: Heart and Vascular Center, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, Philadelphia, PA 19104.
Dr. French: 204 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Drs. Umscheid and Mitchell: 3535 Market Street, Mezzanine, Suite 50, Philadelphia, PA 19104.
Dr. Arnold: Penn Memory Center, 3615 Chestnut Street, Philadelphia, PA 19104.
Dr. Heidenreich: Veterans Affairs Palo Alto Medical Center, 111C Cardiology, 3801 Miranda Avenue, Palo Alto, CA 94304.
Dr. Rader: 11-125 Translational Research Center, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104.
Author Contributions: Conception and design: K. Richardson, M. Schoen, C.A. Umscheid, M.D. Mitchell, E.M. deGoma.
Analysis and interpretation of the data: K. Richardson, M. Schoen, B. French, C.A. Umscheid, M.D. Mitchell, S.E. Arnold, P.A. Heidenreich, D.J. Rader, E.M. deGoma.
Drafting of the article: K. Richardson, M. Schoen, C.A. Umscheid, M.D. Mitchell, E.M. deGoma.
Critical revision of the article for important intellectual content: K. Richardson, M. Schoen, B. French, C.A. Umscheid, M.D. Mitchell, S.E. Arnold, P.A. Heidenreich, D.J. Rader, E.M. deGoma.
Final approval of the article: K. Richardson, M. Schoen, B. French, C.A. Umscheid, M.D. Mitchell, S.E. Arnold, P.A. Heidenreich, D.J. Rader, E.M. deGoma.
Provision of study materials or patients: E.M. deGoma.
Statistical expertise: B. French, C.A. Umscheid, M.D. Mitchell.
Administrative, technical, or logistic support: K. Richardson, M. Schoen, E.M. deGoma.
Collection and assembly of data: K. Richardson, M. Schoen, E.M. deGoma.
Richardson K, Schoen M, French B, Umscheid CA, Mitchell MD, Arnold SE, et al. Statins and Cognitive Function: A Systematic Review. Ann Intern Med. 2013;159:688-697. doi: 10.7326/0003-4819-159-10-201311190-00007
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Published: Ann Intern Med. 2013;159(10):688-697.
Despite the U.S. Food and Drug Administration (FDA) warning regarding cognitive impairment, the relationship between statins and cognition remains unknown.
To examine the effect of statins on cognition.
PubMed, Embase, and Cochrane Library from inception through October 2012; FDA databases from January 1986 through March 2012.
Randomized, controlled trials (RCTs) and cohort, case–control, and cross-sectional studies evaluating cognition in patients receiving statins.
Two reviewers extracted data, 1 reviewer assessed study risk of bias, and 1 reviewer checked all assessments.
Among statin users, low-quality evidence suggested no increased incidence of Alzheimer disease and no difference in cognitive performance related to procedural memory, attention, or motor speed. Moderate-quality evidence suggested no increased incidence of dementia or mild cognitive impairment or any change in cognitive performance related to global cognitive performance scores, executive function, declarative memory, processing speed, or visuoperception. Examination of the FDA postmarketing surveillance databases revealed a low reporting rate for cognitive-related adverse events with statins that was similar to the rates seen with other commonly prescribed cardiovascular medications.
The absence of many well-powered RCTs for most outcomes resulted in final strengths of evidence that were low or moderate. Imprecision, inconsistency, and risk of bias also limited the strength of findings.
Larger and better-designed studies are needed to draw unequivocal conclusions about the effect of statins on cognition. Published data do not suggest an adverse effect of statins on cognition; however, the strength of available evidence is limited, particularly with regard to high-dose statins.
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Cardiology, Dyslipidemia, Coronary Risk Factors.
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