Statin-ARBs Combo May Lower Risk for Dementia, Mortality

TOPLINECombining statins with antihypertensive medications (AHMs) that increase angiotensin II formation was associated with a 12% lower risk of incident dementia and a 13% lower risk of all-cause mortality compared with statins combined with medications that suppress angiotensin II. Rosuvastatin or atorvastatin combined with AHMs that increase angiotensin II formation demonstrated the greatest protective associations.METHODOLOGYResearchers conducted a prospective cohort study using data from the 45 and Up Study in Australia, and included 34,610 propensity score-matched participants aged ≥ 45 years (mean age of 65.8 years; 47.9% women; mean follow-up 12.4 years; 17,305 per group) with hypertension and dyslipidemia who had concurrent statin and AHM use.Participants were classified according to sustained use (proportion of days covered ≥ 80%) of statins plus angiotensin II promoting antihypertensive medications (angiotensin II receptor blockers [ARBs], thiazides, dihydropyridine calcium channel blockers) or statins plus angiotensin II suppressing antihypertensive medications (angiotensin-converting enzyme inhibitors, beta-blockers, non-dihydropyridine calcium channel blockers).Primary outcome was incident dementia; secondary outcomes were all-cause mortality and dementia-related mortality.Cox proportional hazards models adjusted for diet, physical activity, comorbidities (atrial fibrillation, heart failure, coronary heart disease, depression, diabetes mellitus, schizophrenia, stroke), and concomitant medications.TAKEAWAYUse of statins plus angiotensin II promoting AHMs was associated with a 12% lower dementia risk (hazard ratio [HR], 0.88; P = .019) and 13% lower all-cause mortality (HR, 0.87; P < .001) compared with statins plus angiotensin II suppressing AHMs.Rosuvastatin plus angiotensin II promoting AHMs was associated with a 57% lower dementia risk (HR, 0.43; P < .001) and atorvastatin plus angiotensin II promoting AHMs with a 26% lower risk (HR, 0.74; P < .001) compared with simvastatin plus angiotensin II promoting AHMs, while pravastatin plus angiotensin II promoting AHMs was associated with increased dementia risk (HR, 1.31; P = .016).Protective associations were consistent across both sexes and observed only in the 65-74-year age group, with combinations involving ARBs demonstrating superior benefit compared with those involving angiotensin-converting enzyme inhibitors (HR, 0.74; 95% CI, 0.62-0.88).No significant difference was observed for dementia-related mortality between the 2 groups.IN PRACTICE"These findings underscore the relevance of specific statin and AHM combinations for cardiovascular protection and highlight the need for further research to clarify their potential role in dementia prevention," the authors wrote.SOURCEThe study was led by Eyayaw Ashete Belachew, UTAS Health, University of Tasmania, Hobart, Australia. It was published online on July 29 in International Journal of Geriatric Psychiatry.LIMITATIONSThe study was limited by its observational design. Dementia ascertainment relied on administrative records and prescription data, medication dispensing did not confirm adherence, dementia subtypes could not be distinguished, and blood pressure and lipid measurements were unavailable.DISCLOSURESThe study funding source was not reported. Belachew received support through the Tasmanian Graduate Scholarship. Remaining authors reported having no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.