Use of lipid-lowering drugs in older adults with and without dementia: A community-based epidemiological study

OBJECTIVES: To compare the use of lipid-loweringdrugs in community-dwelling older adults with and without dementia. DESIGN: Comparison of lipid-lowering drug use by demented cases and nondemented controls based on secondary analysis of data from a longitudinal epidemiologic study. SETTING: Longitudinal study of a largely rural, low-ocioeconomic community-based cohort of older persons residing in the mid-Monongahela Valley of Southest Pennsylvania (the Monongahela Valley Independent Elders Survey). PARTICIPANTS: Eight hundred forty-five individuals of mean ± standard deviation (SD) age of 80.5 ± 4.6, participating in the fifth biennial wave of data collection. MEASUREMENTS: Demographics; medical history; medication regimen (including examination of prescription bottle labels); self-report of most recent visit to primary care physician (PCP); and standardized clinical assessment to determine presence of dementia, including Clinical Dementia Rating (CDR). RESULTS: One hundred seventy participants (20.1% of total subject cohort) had dementia, with a CDR of 0.5 or greater. Mean ages of demented and nondemented individuals were 83.5 ± 5.1 and 79.8 ± 4.2, respectively. Similar proportions, 87.7% and 89.5%, of these groups reported PCP visits in the previous year. Of the total sample, 9.4% (3.5% of the demented and 10.8% of the nondemented) were taking lipid-lowering drugs. After adjustment for age, sex, education, visit with PCP within the past year, and potential confounding clinical and lifestyle variables (self-reported heart disease, stroke or transient ischemic attacks, hypertension, smoking, and alcohol consumption), dementia was associated with a lower likelihood of taking a lipid-lowering drug (odds ratio = 0.39, 95% confidence interval = 0.16 16-0.95). In post hoc subgroup analyes, similar results were found when restricting lipid-low-ring drugs to statins alone but were not statistically significant. Drug use was not associated with severity of dementia (CDR = 0.5 vs CDR ≥ 1). CONCLUSIONS: Demented individuals were less likely than their nondemented counterparts to be taking lipid-lowering drugs. This finding could reflect different prescribing patterns by physicians for demented and nondemented patients or a possible protective effect of these drugs against dementia.