3.8.0.0 Lipid-‍Low­er­ing Agents and Cogni­tive Func­tion

Al­though this issue has been raised, sev­er­al lines of ev­i­dence point against this as­so­ci­a­tion, as de­tailed in a 2018 Eu­ro­pean Atheroscle­ro­sis So­ci­ety Con­sen­sus Panel state­ment (109). First, there are three large ran­dom­ized tri­als of statin ver­sus place­bo where specific cogni­tive tests were per­formed, and no dif­ferences were seen be­tween statin and place­bo (110-113). In ad­di­tion, no change in cogni­tive func­tion has been re­port­ed in stud­ies with the ad­di­tion of eze­tim­ibe (90) or PCSK9 in­hibitors (93,114) to statin ther­a­py, in­clud­ing among pa­tients treat­ed to very low LDL choles­terol lev­els. In ad­di­tion, the most re­cent sys­tematic re­view of the U.S. Food and Drug Ad­min­is­tra­tion’s (FDA’s) post­mar­ket­ing surveil­lance databas­es, ran­dom­ized con­trolled tri­als, and co­hort, case con­trol, and cross-sec­tional stud­ies eval­u­at­ing cog­ni­tion in pa­tients re­ceiv­ing statins found that pub­lished data do not re­veal an ad­verse ef­fect of statins on cog­ni­tion (115). There­fore, a con­cern that statins or other lipid-‍low­er­ing agents might cause cogni­tive dysfunc­tion or de­men­tia is not cur­rently sup­port­ed by ev­i­dence and should not deter their use in in­di­vid­u­als with di­a­betes at high risk for ASCVD (115).