Are statins harmful for adults with longstanding type 1 diabetes?

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Takeaway

  • Clinicians should discuss possible cognitive risk with patients with type 1 diabetes (T1D) in deciding whether to prescribe them statins.

Why this matters

  • Risks for both cardiovascular disease and cognitive dysfunction are elevated in T1D.

Study design

  • Neurocognitive testing performed 2010-2013 in 108 middle-aged adults with T1D onset at <18 y, 1950-1980; 57 reported ever use of statins.
  • “Cognitive impairment” defined as score 1.5 standard deviations or worse on ≥2 of 7 tasks.
  • Funding: NIH.

Key results

  • Cognitive impairment present in 14% of never users, 32% with 1-6 y of statin use, 47% with 7-12 y (P=.003).
  • Longer statin use duration was significantly related to worse performance on memory (P=.004) and psychomotor speed (P=.012), but no other domains.
  • In logistic regression models, 7-12 y of statin use associated with almost 5-fold higher odds of cognitive impairment vs never use, independent of age or education.
  • Adjusting for coronary artery disease, low density lipoprotein cholesterol, and ApoE4 status did not substantially alter results.
  • Propensity score analyses appeared to rule out confounding by indication.

Limitations

  • Unknown whether statin use preceded cognitive impairment onset.
  • Results may not apply to middle-aged adults with adult-onset T1D.