Statin Use Is Not Associated With Reduced Cardio- and Cerebrovascular Hospitalizations in Older Adults With Dementia

BACKGROUND: Cardiovascular and cerebrovascular diseases are significant global health challenges and leading causes of death worldwide. Although there is substantial evidence supporting the positive effects of statins for both primary and secondary prevention of these diseases, evidence is lacking regarding the benefits in people with dementia. This study investigated the associations between statin use and cardiovascular and cerebrovascular hospitalizations in nursing home residents with and without dementia. METHODS: This retrospective cohort study of nursing home residents with and without dementia using insurance claims data was conducted in Germany between January 2015 and December 2019. Propensity score-based models were used to evaluate the association of statin use with hospitalizations due to cerebrovascular and cardiovascular events among nursing home residents with and without dementia. Subgroup analyses were performed based on the presence or absence of atherosclerotic cardiovascular disease, dementia type, presence of hyperlipidemia, and newly prescribed statin use, as well as age groups, care dependency level, and sex. RESULTS: The final sample included data from 96 162 individuals, 37 262 without dementia, and 58 900 with dementia. Statin use was associated with an increased risk of hospitalization due to cardiovascular or cerebrovascular events among people with dementia (hazard ratio [HR], 1.06 [95% CI, 1.01–1.12]; P =0.023). Moderate and high statin intensity was associated with an increased risk of hospitalization (moderate: HR, 1.15 [95% CI, 1.07–1.23]; P <0.001; high: HR, 1.55 [95% CI, 1.15–2.10]; P =0.005) In subgroup analyses, we found an association between statin use and increased risk of hospitalization among individuals without atherosclerotic cardiovascular disease (HR, 1.30 [95% CI, 1.12–1.52]; P <0.001), with vascular dementia and Alzheimer disease (HR, 1.18 [95% CI, 1.06–1.32]; P =0.003; HR, 1.14 [95% CI, 1.00–1.31]; P =0.047, respectively) as well as among newly prescribed statin users (HR, 2.71 [95% CI, 2.33–3.15]; P <0.001). Among individuals without dementia, we found no differences (HR, 1.03 [95% CI, 0.96–1.11]; P =0.397) in the primary analysis and subanalyses except for the high statin intensity group (HR, 1.51 [95% CI, 1.04–2.19]; P =0.029) and among participants with newly prescribed statins (HR, 1.99 [95% CI, 1.56–2.52]). CONCLUSIONS: In our study, statin use was associated with an increased risk of hospitalization due to cardiovascular or cerebrovascular events among people with dementia. These findings highlight the need for further research and cautious consideration of statin use in people with dementia.