Cholesterol Lowering Statin Drugs DO NOT Encourage Cognitive Decline

Statin drugs are used to lower cholesterol levels in the hope of preventing vascular disease including heart disease, strokes, peripheral arterial vascular disease. They have been safely prescribed to millions of people for years showing great effectiveness.  However, a cloud hangs over them over side effects glorified in the lay media and on the internet.  Oftentimes patients don’t even fill their prescriptions due to their concerns. One of the myths is that statins lead to a premature decline in cognitive function and dementia.

This concern was addressed in the Journal of American College of Cardiology highlighting a study authored by Katherine Samaras, MBBS, PhD of St. Vincents Hospital in Sydney Australia.  They looked at adults aged 70 – 90 over a period of seven years.  Over 1,000 subjects in the study included individuals who did not take statins, individuals who were already using statins and individuals who were started on statins during the study period. The subjects first took a standard mini mental status test which allowed them to exclude anyone already showing signs of dementia. They then did state of the art cognitive testing and memory testing on the subjects over a seven-year period.

They found that there was no difference in the rate of decline of memory or intellectual function between statin users and non-users.  In a small subgroup of patients, they used imaging techniques to look at the brain volume comparing it over time between statin users and non-users. They found that users had more brain volume at the six-year mark than non-users.  They found that users with heart disease who took statins had a slower rate of decline of learning memory than non-users.  This also included users and non-users who have the APOE-4 genotype associated with cognitive decline.

While statins may not be a perfect class of drug, the study clearly demonstrated that the idea that they encourage cognitive decline and dementia at an accelerated rate is completely false.

Non Invasive CT Angiography Preferable To Stress Testing

Coronary CT Angiography appears to be a better tool than stress testing alone for identifying patients with chest pain requiring invasive angiography. The SCOT-HEART investigators showed that patients showing disease on CT Angiography were less likely to show normal coronary arteries when they had the subsequent cardiac catheterization or angiogram. The SCOT-HEART study included 4146 patients who were randomized to receive standard care with or without coronary CT Angiography. David E Newby, MD, of the University of Edinburgh in the UK and associates concluded in the April on line edition of the Journal of the American College of Cardiology “in patients with suspected angina due to coronary heart disease, coronary CT angiography leads to more appropriate use of invasive angiography and alterations in preventative therapies that were associated with a halving of fatal and non-fatal myocardial infarction(s).” Reviewers of the study in editorial comments said that CT angiography had an edge over stress testing because of,” The ability to identify, quantify and characterize atherosclerosis.” CT angiography allows measurement non- invasively of fractional flow reserve providing a clear advantage to traditional stress testing. The major draw backs to CT angiography include cost of about $460 more than stress testing and exposure to ionizing radiation. A traditional CT scan exposes you to about 10 years’ worth of Chest X Ray level radiation.

For the practicing community physician this data will result in our patients with chest pain being sent for Coronary CT Angiography in the Emergency Department when presenting with chest pain, risk factors for heart disease and no clear cut diagnostic EKG changes instead of waiting for a cardiologist and technical team to be available to perform a stress test.