{"id":2543,"date":"2020-10-19T09:29:34","date_gmt":"2020-10-19T09:29:34","guid":{"rendered":"https:\/\/www.danielleal.pt\/?p=2543"},"modified":"2020-10-20T11:05:37","modified_gmt":"2020-10-20T11:05:37","slug":"the-potential-cognitive-effect-of-statins","status":"publish","type":"post","link":"https:\/\/danielleal.pt\/en\/the-potential-cognitive-effect-of-statins\/","title":{"rendered":"The Potential Cognitive Effect of Statins"},"content":{"rendered":"

Statins are a class of drugs used to lower cholesterol levels and treat cardiovascular disease. Given the prevalence of cardiovascular disease, it is not surprising that they are among the world\u2019s most prescribed drugs.<\/span><\/p>\n

All pharmaceutical agents (and many of the nutraceuticals and herbal medicine products) have potential adverse effects.<\/b> It is up to the clinician to inform patients about them to allow an informed decision. These are often difficult decisions because there are inherent advantages and disadvantages to using a given drug.<\/span><\/p>\n

How do statins work?<\/span><\/strong><\/p>\n

In the 1980s, lovastatin was the first statin to be marketed, starting a new era in the treatment of cardiovascular disease. These drugs inhibit a key enzyme in cholesterol synthesis – HMG-CoA-Reductase.<\/b> In this way, statins decrease the production of cholesterol at the cellular level, which reduces the amount of cholesterol that circulates in the blood within the lipoproteins (plasma proteins that have the function of transporting lipids in the blood). Assuming that high concentrations of lipoproteins in the blood (particularly LDL – Low Density Lipoproteins) contribute to increased risk of atherosclerosis, statins are a powerful ally in the treatment and prevention of these diseases.<\/b><\/span><\/p>\n

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Fig. 1 – Biochemical pathway of cholesterol synthesis. HMG-CoA reductase is the rate-limiting enzyme and the target of statins.<\/span><\/h4>\n

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What are the better-known side effects of statins?<\/span><\/strong><\/p>\n

Aside from nonspecific reactions, such as digestive problems, headaches, and insomnia, patients report with some frequency (5-10%, according to estimates) the development of muscle pain as a side effect of statins. <\/b>In more severe cases, there may even be rhabdomyolysis (destruction of muscle tissue). The mechanism behind these myalgias is not fully understood, but it is thought that it may be related to a coenzyme Q10 deficiency. Indeed, coenzyme Q10 is produced from mevalonate, so statins also interfere with their concentrations at the cellular level.<\/b> Coenzyme Q10 plays a fundamental role in the production of energy in cells, specifically in the mitochondria, and it also protects against oxidative stress.<\/span><\/p>\n

Can statins cause cognitive side effects?<\/span><\/strong><\/p>\n

This topic is not consensual in the scientific community, and there are studies with different results. However, the clinical suspicion is relatively high, and the FDA (American agency that controls the safety of pharmaceuticals) has included a warning regarding the possibility of cognitive side effects (loss of memory, confusion, etc.) from the use of statins in 2016 <\/b>(1<\/span><\/a>). A 2019 literature review analyzed the studies published between 1992 and 2018, which looked at the possible relationship between statins and cognitive decline (2<\/span><\/a>). The findings were inconsistent, with some studies suggesting a positive association, while others did not. <\/b>However, the authors of the review highlight the use of unreliable cognitive assessment tests in most studies, which may have underestimated the potential adverse effects. When there are adverse cognitive effects, these tend to reverse after statin interruption.<\/span><\/p>\n

How can statins interfere with cognitive function?<\/span><\/strong><\/p>\n

In the same review, the authors propose two interesting mechanisms to explain the potential effect of statins on the cognitive level:<\/span><\/p>\n