Postconcussion statin use may protect against dementia

  • Redelmeier DA & al.
  • JAMA Neurol
  • 20 May 2019

  • International Clinical Digest
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Takeaway

  • Among older adults sustaining a concussion, those with a statin prescription in the first several postconcussion months had a 13% lower risk of developing dementia.

Why this matters

  • Lack of effective neuroprotective agents after traumatic brain injury (TBI).

Key results

  • 24.5% of patients had a statin prescription within 90 days after concussion.
  • During mean 3.9-year follow-up, 16.4% of study cohort developed dementia.
  • Relative to nonstatin users, statin users had lower dementia risk after adjustment for factors including other cardiovascular medications and neuropsychiatric medications (relative risk, 0.87; P<.001>
  • Reduction was similar across subgroups, increased over time, was distinct from depression risk.
  • No significant protective effect of statins seen after ankle sprain or of nonstatin lipid-lowering drugs.
  • Only other cardiovascular medication class independently protective was angiotensin II receptor blockers (relative risk, 0.88; 95% CI, 0.79-0.98).

Expert comment

  • In an editorial, Rachel A. Whitmer, PhD, writes, “While this study cannot infer causality, it is a first step in accumulating evidence for possible future therapeutic interventions post-TBI and a call for further pharmacoepidemiologic harnessing of integrated health care systems to discover other potential protective or risk factors for dementia after brain injury.”

Study design

  • Canadian population-based cohort study of 28,815 older adults (median age, 76 years) with a concussion diagnosis, excluding those hospitalized because of severity, those with prior dementia or delirium, those dying within 90 days.
  • Main outcome: dementia.
  • Funding: Canada Research Chair in Medical Decision Sciences; Canadian Institutes of Health Research; others.

Limitations

  • Potential unmeasured, residual confounding.
  • Lack of power to assess timing of statin prescription.
  • Possible underestimation of dementia.
  • Limited generalizability.