LAUSR

The care of people with dementia is often prolonged and costly, creating a large health, social and financial burden. In addition, multimorbidity is highly prevalent in people with dementia, including chronic conditions such as hypertension, diabetes mellitus, cardiovascular‐ and cerebrovascular diseases (CVD), and brings the challenge of medication management, which is especially challenging in people with dementia due to cognitive impairment and a potential increase of negative outcomes, such as adverse drug events, hospitalization and mortality. Statins, inhibitors of the HMG‐CoA reductase enzyme, are lipid lowering medications that are beneficial for prevention of cardio‐ and cerebrovascular (CV) events and are recommended for primary and secondary prevention in people with = or > 10% mortality risk due to CVD over a 10‐year period. However, data is mixed for primary prevention in people aged 65 years and older, and there is currently limited information on the efficacy and safety of statin use in the older population. One recent meta‐analysis reported that participants on statins showed an overall reduction of CV events by 21% across all age groups; however, the effect became smaller with increasing age; for example, in patients aged >75 years, this effect was reduced to 13%. As dementia is associated with increased mortality, questions arise whether statin use should continue in people with dementia, especially in advanced stages, when life expectancy is <10 years to obtain the desired risk reduction benefits with regard to CV events. The aim of the present study is to review current international guideline recommendations with regard to statin use and primary prevention of CV events for people with dementia. First, a literature search in MEDLINE and Google Scholar was conducted using the terms “cardiovascular disease” AND “prevention” OR “stroke” AND “prevention” OR “dyslipidemia” OR “diabetes” OR “dementia”. These terms were chosen according to risk factors indicating the initiation of statin therapy such as dyslipidemia, diabetes mellitus and CVD for primary or secondary prevention. Search criteria included clinical practice guidelines (CPGs) in English and German language published from 2011 to 2021. Within the search in German, we added the term “S3 Leitlinie”. In addition, we consulted practicing experts to ensure the inclusion of all currently relevant CPGs. We screened major clinical guidelines for cardiology, neurology, endocrinology, preventative, and care excellence guidelines from United States, United Kingdom, Germany and the World Health Organization (WHO) for specific recommendations on statin use with regard to prevention of CV events in people with dementia. A total of 14 guidelines were identified and reviewed. Each guideline was screened using ‘statin’ OR ‘dementia’ as search terms. Findings were documented in a database. Results are presented in Table 1. As indicated in Table 1, 6 of the 14 guidelines included some information on the overall use of statins in people with dementia as well as on potential effects of statins on cognitive function and dementia risk. However, in none of the screened guidelines, a specific recommendation regarding statins and prevention of CV events among people with dementia nor regarding statins and potential side effects among people with dementia can be found. The WHO guideline highlights the potential role of dyslipidemia management at mid‐life in reducing dementia risk while advising against statin therapy solely for dementia prevention. Five of these guidelines emphasize the need for more evidence on the association between statin use and cognition. To sum up, statins play a key role in the care of older people. However, benefits and risks of statin use with regard to prevention of CV events for people with dementia remain unclear. Present results show that evidence‐based guidelines do not provide sufficient information nor recommendations on the use of statins and CV events in people with dementia for clinicians caring for this population. Furthermore, a recent review by Davis et al. found no study evaluating efficacy of statins in people with dementia and only few studies evaluating potential adverse events. Therefore, future research is urgently needed to better understand the benefits and risks of statins regarding the prevention of CV events in people with dementia. Our research group aims to close exactly this research gap by conducting a study based on German health insurance data, with the main goal to examine potential health benefits and risks of statins with regard to CV events in nursing home residents with and without dementia.