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• W1975075246 abstract "Authors' replySir—In reply to W H Birkenhäger and colleagues, we point out that in another study of the effects of estrogenreplacement therapy on the development of Alzheimer's disease we carefully assessed 80 case records of patients recorded as having dementia or Alzheimer's disease, through the General Practice Research Database. 90% met stringent criteria for the diagnosis.1Seshadri S, Zornberg GL, Derby LE, Myers MW, Jick H, Drachman DA. Postmenopausal estrogen replacement therapy and the risk of Alzheimer's disease. Arch Neurol (in press).Google ScholarWe controlled for patients' general practice in our analysis. Although general practice provides only an indirect indicator of socioeconomic status and education, we suspect that it substantially controls for these factors, as well as for the acumen of and criteria for diagnosing dementia of the individual physicians. We suggest that specific choice of drugs, as well as the decision to treat hyperlipidaemia is not involved in any selection bias, since treatment with non-statin lipidlowering agents had no effect on the risk of dementia.Birkenhäger and colleagues allude to the pharmacological action of statins. However, statins have beneficial effects on vascular endothelium through the increase in activity of endothelial nitricoxide synthase and the reduction of endothelin-1,2Laufs E Endres M Stagliano N et al.Neuroprotection mediated by changes in the endothelial actin cytoskeleton.J Clin Invest. 2000; 106: 15-24Crossref PubMed Scopus (250) Google Scholar, 3Yamada M Huang Z Dalkara T et al.Endothelial nitric oxide synthase-dependent cerebral blood flow augmentation by Larginine after chronic statins treatment.J Cereb Blood Flow Metab. 2000; 20: 709-717Crossref PubMed Scopus (124) Google Scholar and their effects in reducing heart disease and stroke4Rosenson RS Biological basis for statin therapy in stroke prevention.Curr Opin Neurol. 2000; 13: 57-62Crossref PubMed Scopus (28) Google Scholar, 5Warshafsky S Packard D Marks SJ et al.Efficacy of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors for prevention of stroke.J Gen Intern Med. 1999; 14: 763-774Crossref PubMed Scopus (36) Google Scholar exceed their lipid-lowering actions.B M Y Cheung and C R Kumana seem to assume that we studied prevalent cases of dementia. We included only incident cases of ementia. Therefore the data on statin use relate only to the time before the diagnosis. The indication for use was hyperlipidaemia in all statins users. The negative association between statins and dementia was present for all durations of treatment, including 4 or more years before the date of first diagnosis. Our results provide information on the use of statins before the diagnosis of dementia but not on the possible effect of statins in people who already have dementia. Authors' reply Sir—In reply to W H Birkenhäger and colleagues, we point out that in another study of the effects of estrogenreplacement therapy on the development of Alzheimer's disease we carefully assessed 80 case records of patients recorded as having dementia or Alzheimer's disease, through the General Practice Research Database. 90% met stringent criteria for the diagnosis.1Seshadri S, Zornberg GL, Derby LE, Myers MW, Jick H, Drachman DA. Postmenopausal estrogen replacement therapy and the risk of Alzheimer's disease. Arch Neurol (in press).Google Scholar We controlled for patients' general practice in our analysis. Although general practice provides only an indirect indicator of socioeconomic status and education, we suspect that it substantially controls for these factors, as well as for the acumen of and criteria for diagnosing dementia of the individual physicians. We suggest that specific choice of drugs, as well as the decision to treat hyperlipidaemia is not involved in any selection bias, since treatment with non-statin lipidlowering agents had no effect on the risk of dementia. Birkenhäger and colleagues allude to the pharmacological action of statins. However, statins have beneficial effects on vascular endothelium through the increase in activity of endothelial nitricoxide synthase and the reduction of endothelin-1,2Laufs E Endres M Stagliano N et al.Neuroprotection mediated by changes in the endothelial actin cytoskeleton.J Clin Invest. 2000; 106: 15-24Crossref PubMed Scopus (250) Google Scholar, 3Yamada M Huang Z Dalkara T et al.Endothelial nitric oxide synthase-dependent cerebral blood flow augmentation by Larginine after chronic statins treatment.J Cereb Blood Flow Metab. 2000; 20: 709-717Crossref PubMed Scopus (124) Google Scholar and their effects in reducing heart disease and stroke4Rosenson RS Biological basis for statin therapy in stroke prevention.Curr Opin Neurol. 2000; 13: 57-62Crossref PubMed Scopus (28) Google Scholar, 5Warshafsky S Packard D Marks SJ et al.Efficacy of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors for prevention of stroke.J Gen Intern Med. 1999; 14: 763-774Crossref PubMed Scopus (36) Google Scholar exceed their lipid-lowering actions. B M Y Cheung and C R Kumana seem to assume that we studied prevalent cases of dementia. We included only incident cases of ementia. Therefore the data on statin use relate only to the time before the diagnosis. The indication for use was hyperlipidaemia in all statins users. The negative association between statins and dementia was present for all durations of treatment, including 4 or more years before the date of first diagnosis. Our results provide information on the use of statins before the diagnosis of dementia but not on the possible effect of statins in people who already have dementia. Dementia and statinsThe case-control observational study by Hershel Jick and colleagues (Nov 11, 1627)1 raises some important questions over and above researchers' own caveats. Full-Text PDF Dementia and statinsHershel Jick and colleagues1 found a striking inverse association between the use of statins and dementia.1 They admit that casecontrol studies merely identify associations, not causal links, which could be the case in their study. Full-Text PDF" @default.
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• W1975075246 title "Dementia and statins" @default.
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