Neurocognitive Outcomes and Survival with High- vs Low-Intensity Statins in Stroke Survivors: A Propensity Score–Matched Cohort (2010-2025)

BACKGROUND: Stroke survivors face elevated risks of cognitive decline and dementia. Whether initiating high-intensity versus low/moderate-intensity statins after stroke confers additional neurocognitive benefit-beyond vascular risk reduction-remains uncertain. METHODS: Retrospective propensity-matched cohort in TriNetX Research (104 U.S. healthcare organizations). Adults ≥18 years with stroke (ICD-10-CM I60/I61/I63) who received a statin within 7 days were included. EXPOSURE: high-intensity versus low/moderate intensity. One-to-one matching on 24 covariates. PRIMARY OUTCOME: time to first diagnosis of any dementia within 5 years from day 30. Secondary: Alzheimer's disease, vascular dementia, and all-cause mortality. Hazard ratios with 95% CIs were estimated. RESULTS: Of 254,711 eligible patients (148,198 high-intensity; 106,513 low/moderate), matching yielded 206,416 patients (103,208 per group) with good balance (all SMDs <0.10). Over 5 years, incident dementia occurred in 6.6% of the high-intensity group (6,816/103,208) vs 6.9% of the low/moderate group (7,104/103,208) (HR 0.954, 95% CI 0.923-0.986; P=0.005). High-intensity therapy was associated with lower risk of AD (HR 0.882, 95% CI 0.826-0.943; P<0.001) and lower all-cause mortality (HR 0.945, 95% CI 0.926-0.965; P<0.001). There was no significant difference for vascular dementia (HR 1.047, 95% CI 0.996-1.100; P=0.072). CONCLUSION: Initiation of high-intensity statins within 7 days of stroke was associated with modestly lower 5-year dementia and mortality; randomized trials are needed to confirm causality and define agent- and subtype-specific effects.