The Lancet regional health. Europe · 2026
Association between timing of statin treatment after diabetes diagnosis and risk of dementia: a nationwide observational study.
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Ternhamar Tummas, Johansen Mia Ø, Nordestgaard Børge G, Afzal Shoaib
Аннотация
BACKGROUND: The burden of dementia is projected to rise with aging populations, particularly in those with diabetes; however, there are no effective treatments, and attention has turned to prevention through treatment of modifiable risk factors such as low-density lipoprotein cholesterol. We tested the hypothesis that early initiation of statin treatment following type 2 diabetes diagnosis is associated with lower risk of all-cause dementia than delayed or no initiation.
METHODS: Using nationwide registers, we identified 132,585 statin-naïve individuals in Denmark developing type 2 diabetes from 2006 through 2019. Follow-up was until dementia, death, emigration, or December 31, 2021. Using a clone-censor weighting design emulating a target trial we compared: i) no statin within 5 years after diagnosis (reference), ii) late statin (start at 1-5 years), and iii) early statin (start at ≤ 1 year). The primary outcome was 10-year risk of all-cause dementia based on Aalen-Johansen survival curves with death treated as competing risk.
FINDINGS: During median 7.1 years of follow-up (interquartile range: 3.8-9.9 years), 3592/132,585 = 2.7% developed dementia. Estimated 10-year absolute risks of dementia from the weighted Aalen-Johansen analysis were 3.9% in those with no statin initiation, 3.3% in those with early statin initiation, and 3.5% in those with late statin initiation. Following diabetes diagnosis and compared to no statin initiation, early statin treatment was associated with 15% lower relative risk of dementia at 10 years (95% confidence interval: 9%-21%) while the corresponding relative risk for late statin treatment was 10% lower (3%-15%). Corresponding absolute risk differences were 0.59% (0.34%-0.86%) and 0.38% (0.12%-0.61%) lower, respectively.
INTERPRETATION: In statin-naïve individuals developing type 2 diabetes, statin therapy was associated with lower relative and absolute risks of dementia, most pronounced in those with early statin initiation. There is a need for trial evidence to confirm the findings.
FUNDING: The Danish Cardiovascular Academy and the Danish Heart Foundation.
METHODS: Using nationwide registers, we identified 132,585 statin-naïve individuals in Denmark developing type 2 diabetes from 2006 through 2019. Follow-up was until dementia, death, emigration, or December 31, 2021. Using a clone-censor weighting design emulating a target trial we compared: i) no statin within 5 years after diagnosis (reference), ii) late statin (start at 1-5 years), and iii) early statin (start at ≤ 1 year). The primary outcome was 10-year risk of all-cause dementia based on Aalen-Johansen survival curves with death treated as competing risk.
FINDINGS: During median 7.1 years of follow-up (interquartile range: 3.8-9.9 years), 3592/132,585 = 2.7% developed dementia. Estimated 10-year absolute risks of dementia from the weighted Aalen-Johansen analysis were 3.9% in those with no statin initiation, 3.3% in those with early statin initiation, and 3.5% in those with late statin initiation. Following diabetes diagnosis and compared to no statin initiation, early statin treatment was associated with 15% lower relative risk of dementia at 10 years (95% confidence interval: 9%-21%) while the corresponding relative risk for late statin treatment was 10% lower (3%-15%). Corresponding absolute risk differences were 0.59% (0.34%-0.86%) and 0.38% (0.12%-0.61%) lower, respectively.
INTERPRETATION: In statin-naïve individuals developing type 2 diabetes, statin therapy was associated with lower relative and absolute risks of dementia, most pronounced in those with early statin initiation. There is a need for trial evidence to confirm the findings.
FUNDING: The Danish Cardiovascular Academy and the Danish Heart Foundation.