New insights on statins: For some, they can reduce risk of dementia; for others, they can be replaced with better, cheaper drugs
Key Takeaways
Industry Buzz
“Muscle aches or myalgias are the most common complaint, and for some patients, it’s enough to make them stop taking the medication. More recently, I’ve had patients bring up concerns about memory loss and 'statin transaminitis' likely due to mixed messages in the media.” - Raj Dasgupta, MD, board-certified physician
“Some patients love the idea of ‘natural’ options, but the evidence supporting most of them is inconsistent. Statins still have the strongest track record.” - Raj Dasgupta, MD, board-certified physician
Statins are in the spotlight once again! After decades of debate over statins' neuroprotective versus neurodegenerative effects, new data leans toward the former. A meta-analysis from 55 observational studies including over 7 million patients found a 63% reduction in Alzheimer's and dementia risk among statin users, particularly those taking the drug for over three years.[]
Related: Managing statin-induced brain fog: New insights may mean new protocol for your clinicStatins improve cerebral blood flow, potentially aiding in amyloid plaque clearance and reducing inflammation—both key factors in cognitive decline. The evidence remains mixed on whether statins help or worsen some of these processes.
Also, we still don’t know if statins would exert the same impact on cognition in patients without cardiovascular dysfunction. Ongoing STAREE and PREVENTABLE trials aim to determine (among other endpoints) whether statins can prevent dementia in older adults (≥70 years) who have yet to develop cardiovascular disease, or whether observed benefits stem from improved heart health.[][]
Adherence issues
According to a 2019 report published in the Journal of the American Heart Association, fear of side effects is by far the most common reason for patients’ discontinuation of statins.[] A 2024 systematic review from Pharmacoepidemiology and Drug Safety found that in the United States, statin discontinuation rates within the first year range from 6.9% to 55%, with cost being a major barrier.[]
“Muscle aches or myalgias are the most common complaint, and for some patients, it’s enough to make them stop taking the medication,” said board-certified physician Raj Dasgupta, MD. He further adds, “More recently, I’ve had patients bring up concerns about memory loss and 'statin transaminitis' likely due to mixed messages in the media.” He, too, also cites cost and accessibility as key factors in low adherence.
Alternative lipid-lowering therapies
For patients unable to tolerate statins, alternatives are available but come with limitations. PCSK9 inhibitors, including evolocumab, alirocumab, and inclisiran, have proven effective in lowering LDL cholesterol, but as board-certified cardiologist Robert Segal, MD, notes, their high cost makes them a secondary choice.
Related: Doctors—and their patients—are losing faith in statins: 3 reasons they fall shortDr. Dasgupta points to ezetimibe as an add-on therapy when LDL remains elevated despite statins, while bempedoic acid offers another option, particularly for patients experiencing muscle-related side effects from statins.
There's also other options coming down the pipline. Obicetrapib, a CETP inhibitor, is emerging as a potential alternative to statins, aiming to lower LDL cholesterol with fewer side effects. Currently in clinical trials, it shows promise for patients who cannot tolerate statins due to side effects like muscle pain or brain fog.
It raises the question: Do statins directly enhance cognitive function, or is the benefit simply from lowering LDL?
Nutraceuticals
Nutraceuticals like red yeast rice, fiber, and plant sterols are gaining attention for cholesterol management. Red yeast rice, in particular, has sparked interest on social media due to its LDL-lowering effects, attributed to monacolin K, a compound structurally identical to lovastatin, a prescription statin.[]
One Reddit user claimed, “Red yeast rice is a statin, and if you get it from a good company it is also quality controlled. It’s easier and cheaper than going to a doctor, why waste time and money on the same thing?”
However, the FDA classifies red yeast rice products containing high amounts of monacolin K as an unapproved drug, leading to their removal from the market. Consequently, most commercial red yeast rice supplements may contain little to no monacolin.
Experts urge caution when considering nutraceuticals as a replacement for statins. “Nutraceuticals are a nice complement but not an alternative to statins until evidence suggests so,” says Dr. Segal.
Dr. Dasgupta echoes this sentiment: “Some patients love the idea of ‘natural’ options, but the evidence supporting most of them is inconsistent. Statins still have the strongest track record.”