Statin use and cognitive function in middle-aged adults with type 1 diabetes

AIM To test associations between statin use and cognitive impairment in adults with childhood-onset type 1 diabetes(T1D).METHODS In 2010-13, n = 108 middle-aged participants from ongoing observational Pittsburgh Epidemiology of Diabetes Complications Study underwent neurocognitive assessment(mean age and T1 D duration of 49 and 41 years, respectively). All were diagnosed with childhoodonset(i.e., prior to age 18) T1 D between 1950 and 1980 and were seen within one year of diagnosis at Children's Hospital of Pittsburgh. Self-reported statin use(yes/no and if yes, name of statin) was collected biennially from parent study baseline(1986-1988) to time of neurocognitive testing. Logistic regression models tested associations between statin use groups and cognitive impairment(defined as having two or more cognitive test scores 1.5SD or worse than published norms) while linear regression models tested associations between statin use groups and cognitive domain z-scores(domains: Verbal IQ, memory, executive function, psychomotor speed, and visuo-construction). All models controlled for education and age. To address confounding by indication, models were repeated using a propensity score for statin use.RESULTS Of the 108 participants, 51 reported never using statins. Median duration of statin use among the 57 ever users was 6 years. These 57 ever statin users were split to create two groups(≤ or > median years of statin use): 1-6 years(n = 25), and 7-12 years(n = 32). Compared with never users, using statins 1-6 years tripled the odds of cognitive impairment(OR = 3.16; 95%CI: 0.93-10.72; P = 0.06) and using statins 7-12 years almost quintupled the odds of cognitive impairment(OR = 4.84; 95%CI: 1.63-14.44; P = 0.005). Compared with never users, using statins 1-6 or 7-12 years was related to worse performance in the memory domain(β =-0.52; P = 0.003, and-0.39; P = 0.014, respectively). Adjusting for coronary artery disease, low density lipoprotein cholesterol, and Apo E4 status did not substantially alter results, and none of these covariates were significantly related to cognitive outcomes(all P > 0.05). Propensity score analyses support that associations between poor cognitive outcomes and statin use were not due merely to confounding by indication. CONCLUSION Statin use was associated with cognitive impairment, particularly affecting memory, in these middle-aged adults with childhood-onset T1 D, whom at this age, should not yet manifest age-related memory deficits.

Statin use and risk of liver cancer: A meta-analysis of 7 studies involving more than 4.7 million patients

AIM： To pool data currently available to determine the association between statin use and the risk of liver cancer.METHODS： A computerized literature search was conducted to identify those relevant studies between Janu-ary 1966 and March 2013. Stata 11.0 （Stata Corp, College Station, Texas） was used for statistical analyses. Pooled relative risk （RR） estimates with 95%CI were calculated for overall analysis and subgroup analyses, using the random- and fxed-effects models. Heteroge-neities between studies were evaluated by Cochran’s Q test and I^2 statistic. The Begg’s funnel plot and Egger’s regression asymmetry test were used to detect the publication bias.RESULTS： Seven studies were included in our meta-analysis according to the selection criteria, including four cohort studies and three case-control studies. These studies involved 4725593 people and 9785 liver cancer cases. The overall analysis showed that statin use was statistically associated with a signifcantly reduced risk of liver cancer （random-effects model, RR=0.61, 95%CI： 0.49-0.76, P 〈 0.001; fxed-effects mod-el, RR=0.64, 95%CI： 0.57-0.71, P 〈 0.001）; however, significant heterogeneity was found between studies （Cochran’s Q statistic=19.13, P=0.004; I^2 = 68.6%）. All subgroup analyses provided supporting evidence for the results of overall analysis. Begg’s （Z=0.15, P=0.881） and Egger’s test （ t=-0.44, P=0.681） showed no signifcant risk of having a publication bias.CONCLUSION： Statin use was associated with the reduced risk of liver cancer. To clearly clarify this relationship, more high quality studies are required.

Impact of cardiologist intervention on guideline-directed use of statin therapy

BACKGROUND Statins have an important and well-established role in the prevention of atherosclerotic cardiovascular disease(ASCVD).However,several studies have reported widespread underuse of statins in various practice settings and populations.Review of relevant literature reveals opportunities for improvement in the implementation of guideline-directed statin therapy(GDST).AIM To examine the impact of cardiologist intervention on the use of GDST in the ambulatory setting.METHODS Patients with at least one encounter at the adult Internal Medicine Clinic(IMC)and/or Cardiology Clinic(CC),who had an available serum cholesterol test performed,were evaluated.The 2 comparison groups were defined as:(1)Patients only seen by IMC;and(2)Patients seen by both IMC and CC.Patients were excluded if variables needed for calculation of ASCVD risk scores were lacking,and if demographic information lacked guideline-directed treatment recommendations.Data were analyzed using student t-tests or χ^2,as appropriate.Analysis of Variance was used to compare rates of adherence to GDST.RESULTS A total of 268 patients met the inclusion criteria for this study;211 in the IMC group and 57 in the IMC-CC group.Overall,56%of patients were female,mean age 56 years(±10.65,SD),22%Black or African American,56%Hispanic/Latino,14%had clinical ASCVD,13%current smokers,66%diabetic and 63%hypertensive.Statin use was observed in 55%(n=147/268)of the entire patient cohort.In the IMC-CC group,73.6%(n=42/57)of patients were prescribed statin therapy compared to 50.7%(n=107/211)of patients in the IMC group(P=0.002).In terms of appropriate statin use based on guidelines,there was no statistical difference between groups[IMC-CC group 61.4%(n=35/57)vs IMC group,55.5%(n=117/211),P=0.421].Patients in the IMC-CC group were older,had more cardiac risk factors and had higher proportions of non-white patients compared to the IMC group(P<0.02,all).CONCLUSION Although overall use of GDST was suboptimal,there was no statistical difference in appropriate statin use based on guidelines between groups managed by general internists alone or co-managed with a cardiologist.These findings highlight the need to design and implement strategies to improve adherence rates to GDST across all specialties.