kathie asked
I am 85 - on simvastatin for many years. recently read in Dr. Bredesen's book on Alzheimers that simvastatin is contraindicated for my age (need more cholesterol). Husband has Mild Cognitive Impairment (MCI) and I wish to help him titrate down and help myself as well.
Answer
Simvastatin is a HMG-CoA Reductase inhibitor which reduces the production of cholesterol in the body. The 2013 ACC/AHA Cholesterol Guidelines is the current standard is assessing patient benefit of statin therapy.
Continued statin use in patients over the age of 75 is supported through studies. What is questioned in current guidelines is if there is support in starting new high intensity statin therapy for the prevention of atherosclerotic cardiovascular disease (ASCVD).
Age is not a contraindication to statin use set forth by the FDA. Geriatric patients are recommended to use caution however as advanced age is a predisposing factor for myopathy.
Much of the decision to start new statin therapy in patients with ASCVD risk is left up to the prescriber and of course, the patient. Also, continuing the use of current statin therapy past the age of 75 depends upon a variety of considerations including:
- How the patient is tolerating the current drug.
- Continued risk assessment for future cardiovascular events.
- Cognitive family history of the patient.
Use of Statins and the Effects on Cognitive Ability
Having not read Dr Bredesen's book, I cannot comment on the views of Dr. Bredesen. The information presented here will be a review of studies currently available on statin therapy, like Simvastatin, and the effects statins may have on cognitive ability.
One study in particular does a good job of reviewing literature studying the likelihood of statins causing cognitive impairment or protecting against cognitive impairment. There have been post marketing incidence of patients reporting reversible cognitive impairments that improved with the discontinuation of the drug.
In 2012, the FDA issued a drug safety communication to consumer advising of the small increased risk of reversible cognitive impairment that statins may cause in certain patients. The FDA believes the benefits of statins far outweigh this small, increased risk.
Per the FDA:
There have been rare post-marketing reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use. These reported symptoms are generally not serious and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks).
