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Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk
BACKGROUND: Hyperlipidemia and hypertension are modifiable risk factors for Alzheimer’s disease and related dementias (ADRD). Approximately 25% of adults over age 65 use both antihypertensives (AHTs) and statins for these conditions. While a growing body of evidence found statins and AHTs are indepe...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055882/ https://www.ncbi.nlm.nih.gov/pubmed/32130251 http://dx.doi.org/10.1371/journal.pone.0229541 |
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author | Barthold, Douglas Joyce, Geoffrey Diaz Brinton, Roberta Wharton, Whitney Kehoe, Patrick Gavin Zissimopoulos, Julie |
author_facet | Barthold, Douglas Joyce, Geoffrey Diaz Brinton, Roberta Wharton, Whitney Kehoe, Patrick Gavin Zissimopoulos, Julie |
author_sort | Barthold, Douglas |
collection | PubMed |
description | BACKGROUND: Hyperlipidemia and hypertension are modifiable risk factors for Alzheimer’s disease and related dementias (ADRD). Approximately 25% of adults over age 65 use both antihypertensives (AHTs) and statins for these conditions. While a growing body of evidence found statins and AHTs are independently associated with lower ADRD risk, no evidence exists on simultaneous use for different drug class combinations and ADRD risk. Our primary objective was to compare ADRD risk associated with concurrent use of different combinations of statins and antihypertensives. METHODS: In a retrospective cohort study (2007–2014), we analyzed 694,672 Medicare beneficiaries in the United States (2,017,786 person-years) who concurrently used both statins and AHTs. Using logistic regression adjusting for age, socioeconomic status and comorbidities, we quantified incident ADRD diagnosis associated with concurrent use of different statin molecules (atorvastatin, pravastatin, rosuvastatin, and simvastatin) and AHT drug classes (two renin-angiotensin system (RAS)-acting AHTs, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin-II receptor blockers (ARBs), vs non-RAS-acting AHTs). FINDINGS: Pravastatin or rosuvastatin combined with RAS-acting AHTs reduce risk of ADRD relative to any statin combined with non-RAS-acting AHTs: ACEI+pravastatin odds ratio (OR) = 0.942 (CI: 0.899–0.986, p = 0.011), ACEI+rosuvastatin OR = 0.841 (CI: 0.794–0.892, p<0.001), ARB+pravastatin OR = 0.794 (CI: 0.748–0.843, p<0.001), ARB+rosuvastatin OR = 0.818 (CI: 0.765–0.874, p<0.001). ARBs combined with atorvastatin and simvastatin are associated with smaller reductions in risk, and ACEI with no risk reduction, compared to when combined with pravastatin or rosuvastatin. Among Hispanics, no combination of statins and RAS-acting AHTs reduces risk relative to combinations of statins and non-RAS-acting AHTs. Among blacks using ACEI+rosuvastatin, ADRD odds were 33% lower compared to blacks using other statins combined with non-RAS-acting AHTs (OR = 0.672 (CI: 0.548–0.825, p<0.001)). CONCLUSION: Among older Americans, use of pravastatin and rosuvastatin to treat hyperlipidemia is less common than use of simvastatin and atorvastatin, however, in combination with RAS-acting AHTs, particularly ARBs, they may be more effective at reducing risk of ADRD. The number of Americans with ADRD may be reduced with drug treatments for vascular health that also confer effects on ADRD. |
format | Online Article Text |
id | pubmed-7055882 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-70558822020-03-13 Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk Barthold, Douglas Joyce, Geoffrey Diaz Brinton, Roberta Wharton, Whitney Kehoe, Patrick Gavin Zissimopoulos, Julie PLoS One Research Article BACKGROUND: Hyperlipidemia and hypertension are modifiable risk factors for Alzheimer’s disease and related dementias (ADRD). Approximately 25% of adults over age 65 use both antihypertensives (AHTs) and statins for these conditions. While a growing body of evidence found statins and AHTs are independently associated with lower ADRD risk, no evidence exists on simultaneous use for different drug class combinations and ADRD risk. Our primary objective was to compare ADRD risk associated with concurrent use of different combinations of statins and antihypertensives. METHODS: In a retrospective cohort study (2007–2014), we analyzed 694,672 Medicare beneficiaries in the United States (2,017,786 person-years) who concurrently used both statins and AHTs. Using logistic regression adjusting for age, socioeconomic status and comorbidities, we quantified incident ADRD diagnosis associated with concurrent use of different statin molecules (atorvastatin, pravastatin, rosuvastatin, and simvastatin) and AHT drug classes (two renin-angiotensin system (RAS)-acting AHTs, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin-II receptor blockers (ARBs), vs non-RAS-acting AHTs). FINDINGS: Pravastatin or rosuvastatin combined with RAS-acting AHTs reduce risk of ADRD relative to any statin combined with non-RAS-acting AHTs: ACEI+pravastatin odds ratio (OR) = 0.942 (CI: 0.899–0.986, p = 0.011), ACEI+rosuvastatin OR = 0.841 (CI: 0.794–0.892, p<0.001), ARB+pravastatin OR = 0.794 (CI: 0.748–0.843, p<0.001), ARB+rosuvastatin OR = 0.818 (CI: 0.765–0.874, p<0.001). ARBs combined with atorvastatin and simvastatin are associated with smaller reductions in risk, and ACEI with no risk reduction, compared to when combined with pravastatin or rosuvastatin. Among Hispanics, no combination of statins and RAS-acting AHTs reduces risk relative to combinations of statins and non-RAS-acting AHTs. Among blacks using ACEI+rosuvastatin, ADRD odds were 33% lower compared to blacks using other statins combined with non-RAS-acting AHTs (OR = 0.672 (CI: 0.548–0.825, p<0.001)). CONCLUSION: Among older Americans, use of pravastatin and rosuvastatin to treat hyperlipidemia is less common than use of simvastatin and atorvastatin, however, in combination with RAS-acting AHTs, particularly ARBs, they may be more effective at reducing risk of ADRD. The number of Americans with ADRD may be reduced with drug treatments for vascular health that also confer effects on ADRD. Public Library of Science 2020-03-04 /pmc/articles/PMC7055882/ /pubmed/32130251 http://dx.doi.org/10.1371/journal.pone.0229541 Text en © 2020 Barthold et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Barthold, Douglas Joyce, Geoffrey Diaz Brinton, Roberta Wharton, Whitney Kehoe, Patrick Gavin Zissimopoulos, Julie Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk |
title | Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk |
title_full | Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk |
title_fullStr | Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk |
title_full_unstemmed | Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk |
title_short | Association of combination statin and antihypertensive therapy with reduced Alzheimer’s disease and related dementia risk |
title_sort | association of combination statin and antihypertensive therapy with reduced alzheimer’s disease and related dementia risk |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055882/ https://www.ncbi.nlm.nih.gov/pubmed/32130251 http://dx.doi.org/10.1371/journal.pone.0229541 |
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