American Heart Association: Use of statins does not pose undue risk of neurological complications

The University of Kentucky Public Relations & Strategic Communications Office provides a weekly health column available for use and reprint by news media. This week’s column is by Larry Goldstein, M.D., chair of the University of Kentucky’s Department of Neurology, co-director of the Kentucky Neuroscience Institute and interim medical director of the UK HealthCare/Norton Healthcare – Stroke Care Network.

LEXINGTON, Ky. (June 24, 2024) - Statins, drugs often used in the treatment of patients with or at higher risk of atherosclerotic cardiovascular disease, do not put people at an increased risk of neurological complications, the American Heart Association (AHA) said in a recently issued scientific statement.

A committee I have the privilege of chairing recently wrote the AHA statement, which is connected to a core function of statins: reducing low-density lipoprotein cholesterol (LDL-C). High levels of LDL-C are associated with atherosclerosis, or the thickening and hardening of the arteries. This can lead to heart attack, stroke, blood clots and other complications affecting the cardiovascular system. 

We know that statins and other medications to lower cholesterol levels have a dramatic impact in reducing the risk for cardiovascular disease in general, but cardiac disease and stroke in particular. However, these medications aren’t prescribed as frequently as they could be, in part, because of concern about potential side effects. There isn’t any credible evidence that lipid lowering with statins or other medications increases the risk of developing Alzheimer’s disease or major cognitive impairment which have been public concerns.

Some older studies suggested that statins and the lowering of LDL-C might be associated with cognitive impairment or dementia. According to the AHA, “the preponderance of observational studies and data from randomized trials do not support this conclusion.” Additionally, there is no evidence that the use of statins and other lipid lowering medications worsens the symptoms of patients already diagnosed with Alzheimer’s disease, dementia or other cognitive impairments.

The AHA statement also notes the risk of a hemorrhagic stroke in patients with no cerebrovascular disease is “small and consistently nonsignificant.” A hemorrhagic stroke is caused by the rupture of a blood vessel in or on the brain; they are responsible for about 13 percent of stroke cases.

In primary prevention, folks who haven’t had a stroke or myocardial infarction (heart attack), but are at risk because of high lipid level or other factors, there is virtually no evidence that lowering lipid levels — even to very low levels — increases the risk of brain hemorrhage.

What does this mean?

• Patients who use a statin or other drug to lower LDL-C are not at increased risk of developing Alzheimer’s disease or other major cognitive impairment.
• Patients who use a statin or other drug to lower LDL-C, and have not suffered a stroke or heart attack, are not at increased risk of hemorrhagic stroke.
• Patients living with Alzheimer’s disease or another form of cognitive impairment are not at increased risk of worsening symptoms if they also use a statin or other drug to lower LDC-C.
• There is a significant number of patients who could benefit from statins and other lipid-lowering drugs who do not currently use them.

The benefit in reducing stroke, myocardial infarction and vascular events well outweigh even the small, theoretic risk. The gap between the use of these medications and the potential benefit is pretty wide. There is a large population of patients who could benefit who are not taking advantage of these medications or of this treatment approach. As always, patients should discuss the potential benefits and risks of any treatment with their health care provider.

If you would like to learn more, click here to watch a video about the statement.