Journal Article

Lipoprotein levels and statin treatment related to dementia and cognitive decline in individuals with type 2 diabetes: an observational analysis from the ADVANCE study

Pikkemaat, Miriam, af Geijerstam, Peder, Peters, Ruth, Woodward, Mark, Marre, Michel, Harris, Katie, Chalmers, John, Mancia, Giuseppe

2025

Overview

Introduction Studies on the association between lipid levels and lipid-lowering treatment and the risk of dementia and/or cognitive decline (CD) have shown conflicting results and are few in individuals with type 2 diabetes (T2D). The aim was to evaluate the relationship of baseline LDL cholesterol levels and statin treatment with the development of dementia/CD in patients with T2D from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation trial. Methods Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and CD was defined as at least a 3-point decrement in the Mini Mental State Examination score. Exposures were baseline LDL cholesterol levels, statin treatment at baseline, and statin treatment initiation during the first 18 months of follow-up. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% CI for the composite of dementia/CD. Results Of 11,140 participants, 1827 (16.4%) developed dementia/CD over the 5-year follow up. The OR (95% CI) of dementia/CD were 1.06 (1.00–1.14) per standard deviation higher in baseline LDL cholesterol and 0.90 (0.79–1.03) for participants with vs without statin treatment. Conclusion We observed an association between LDL levels, but not statin treatment, and incident dementia/CD. Although causality cannot be determined by our study, the results are in line with multiple randomised controlled trials. However, to understand the long-term effects of lipid levels and statin treatment on dementia/CD, studies of longer follow-up are still needed.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Aged / Angiology / Biomarkers - blood / Cardiology / Cardiology and Cardiovascular Disease / Cholesterol / Cholesterol, LDL - blood / Clinical Medicine / Clinical trials / Cognition - drug effects / Cognitive ability / Cognitive decline / Cognitive Dysfunction - blood / Cognitive Dysfunction - diagnosis / Cognitive Dysfunction - epidemiology / Cognitive Dysfunction - psychology / Dementia / Dementia - blood / Dementia - diagnosis / Dementia - epidemiology / Dementia - psychology / Dementia disorders / Diabetes / Diabetes complications / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - diagnosis / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - epidemiology / Dyslipidemias - blood / Dyslipidemias - diagnosis / Dyslipidemias - drug therapy / Dyslipidemias - epidemiology / FDA approval / Female / Glucose / High density lipoprotein / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Incidence / Kardiologi och kardiovaskulära sjukdomar / Klinisk medicin / Lipids / Long-term effects / Low density lipoprotein / Male / Medical and Health Sciences / Medicin och hälsovetenskap / Medicine / Medicine & Public Health / Mental disorders / Middle Aged / Randomized Controlled Trials as Topic / Regression analysis / Risk Assessment / Risk Factors / Sensitivity analysis / Statins / Time Factors / Treatment Outcome / Triglycerides / Vascular diseases