March 2025 Newsletter | Statins and Brain Health
My mission is to be the first woman in 4 generations to not develop Alzheimer’s Disease (AD). On my journey of discovering ways to mitigate my risk, I pass this information on to you in this Brain-Body-Health (BBH) Newsletter.
Hello Brain-Body-Health Citizen Scientists!
Statins and Brain Health
Why would I be talking about statins in this brain health newsletter?
We used to think that most dementias belonged to a single cause. However, scientists have figured out that dementias have multiple causes. For instance, Alzheimer’s Disease (AD) is the most common form of dementia and vascular dementia is a close second. These two forms of dementia are not mutually exclusive. Indeed, they often present together. Which comes first is based on clinical presentation, signs and symptoms. I’ll use my father’s brain as an example. He had dementia due to multiple causes. He was diagnosed with vascular dementia, which high blood pressure put him at risk for. Next was dementia due to alcohol use disorder, and finally, he also carried the APOE4 gene, and therefore was at higher risk of AD. It’s important to figure out the root cause so treatment can target it.
That is why we’re talking about statins today. Vascular dementia is a type of dementia caused by reduced blood flow to the brain, often due to a stroke or a series of small strokes. The brain cells do not get enough oxygen and nutrients, which can lead to cognitive decline, memory problems, difficulty with reasoning, and sometimes mood changes. It can develop gradually or suddenly, depending on the underlying cause.
Key risk factors for vascular dementia include:
Age
High blood pressure
High cholesterol
Diabetes
Smoking
Heart disease
Vascular dementia is often associated with conditions that affect blood vessels, such as atherosclerosis (the hardening of the arteries) which can impair blood flow to the brain.
Statins work by:
Lowering cholesterol: thereby reducing fatty plaques in arteries.
Preventing strokes: reduces the likelihood of developing vascular dementia.
Improving blood vessel health: stabilizes plaques preventing ruptures.
Improving overall cardiovascular health: beyond lowering cholesterol they reduce inflammation in the blood vessels, which may further reduce the risk of vascular events.
However, statins are not the only solution for managing cholesterol. A healthy diet, exercise, and lifestyle changes are also important components in managing cholesterol levels and preventing cardiovascular disease (CVD).
Here are some key points from current research:
1. Potential Cognitive Side Effects:
Large-scale studies and systematic reviews have not consistently confirmed a clear link between statin use and cognitive impairment.
Mechanism: Statins lower cholesterol, which is important in the formation of brain cells and neurotransmitters. Some hypothesize that lowering cholesterol might interfere with cognitive processes, though this has not been definitively proven.
Risk Factors: Older adults, particularly those over 70, might be at a higher risk of experiencing cognitive issues when using statins. However, the benefits of statins in reducing cardiovascular risk often outweigh these potential risks.
2. Neuro-protective Effects:
Cholesterol in the brain plays a key role in maintaining the structure and function of neurons, and statins might help reduce the risk of neurodegenerative diseases like Alzheimer's and Parkinson's. Statins' anti-inflammatory and antioxidant effects might also be beneficial for brain health.
Alzheimer's Disease: Some studies have shown a potential protective effect, while others found no significant association.
Stroke: Statins are known to reduce the risk of stroke, and this could contribute to better brain health, particularly in individuals at risk of cerebrovascular events.
3. Impact on Brain Blood Flow:
Statins have been shown to improve endothelial function and blood flow, which can have positive effects on brain health. Improved blood flow might help reduce the risk of stroke or improve recovery after a stroke, which could be beneficial for cognitive function.
4. Research Inconsistencies:
While there have been numerous studies on the topic, the findings are not always consistent. Some studies report no impact on cognition or mental function, while others indicate potential cognitive side effects. This inconsistency can be attributed to differences in study design, patient populations, and the type of statins used.
5. What about BRAIN EFFECTS?
The overall consensus is that the cardiovascular benefits of statins outweigh the potential risk for cognitive side effects in the majority of patients.
Overall, the effects of statins on brain health remain a complex topic, with both potential benefits and risks. The evidence does not conclusively support a direct harmful impact of statins on the brain, but there is enough concern to warrant further research, particularly in older populations or those at risk for cognitive decline. If you are concerned about statin use and its effects on your brain health, it's important to discuss your concerns with your healthcare provider.
Deciding whether to take a statin is an important health decision
Statins are commonly prescribed to lower cholesterol and reduce the risk of heart disease and vascular dementia, but they are not appropriate for everyone. Here are a few factors to consider when determining whether you should take a statin:
1. Your Cholesterol Levels
Statins are typically prescribed if you have high LDL cholesterol (often referred to as "bad" cholesterol).
The liver produces most of the cholesterol the body needs, a small amount of comes from the foods we eat.
2. Your Risk of Heart Disease or Stroke
Statins are often recommended for people with an increased risk of heart disease or stroke. This includes individuals with:
A history of CVD (like heart attacks, strokes, or peripheral artery disease).
Risk factors such as high blood pressure, smoking, diabetes, or family history of heart disease.
Tools like the ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator help estimate your 10-year risk of heart disease and stroke. If your risk is above a certain threshold, your doctor might suggest statins.
3. Your Age
People aged 40-75 with no history of CVD but with risk factors (like high cholesterol or high blood pressure) might be more likely to benefit from statins.
The specific age range and risk factors your doctor considers will depend on guidelines like those from the American College of Cardiology (ACC) and American Heart Association (AHA).
4. Diabetes/Prediabetes/Insulin Resistance
If you have these conditions and are over 40, statins are commonly recommended to prevent heart disease and reduce cardiovascular risk in people even if your cholesterol is not high.
5. Potential Side Effects
Statins can cause side effects such as muscle pain, liver enzyme abnormalities, and, rarely, more severe issues like rhabdomyolysis (muscle breakdown).
6. Lifestyle Factors
Diet and exercise: If lifestyle changes like eating a heart-healthy diet and exercising regularly have not sufficiently improved your cholesterol or cardiovascular health, statins might be considered.
7. Genetic Factors
Some individuals may have genetic conditions, like familial hypercholesterolemia, that significantly raise cholesterol levels. In these cases, statins are often prescribed earlier and at higher doses.
8. How to Make the Decision
Talk to your healthcare provider: They will assess your overall cardiovascular risk, cholesterol levels, other health conditions, and family history.
Understand the benefits and risks: Statins can lower the risk of heart attacks, strokes, and death from heart disease, but there are potential side effects to consider.
Consider your personal values: Some people may prefer to avoid medication if possible, while others may be more inclined to take statins for the long-term health benefits.
Ultimately, the decision to take a statin should be personalized based on your health profile. A healthcare provider can help guide you through the decision-making process by discussing these factors in more detail.
To make an informed decision you will need these markers:
ApoB - a cholesterol transport lipoproteins that play a crucial role in the formation of plaque within arteries. A simple cheap blood test. It’s not widely tested like it should be, according to lipidologists. Routine in BBH work-up.
Coronary calcium score - a non-invasive imaging test that measures the amount of calcium deposits in the coronary arteries, of the heart. Takes about 5 minutes. Routine in BBH work-up. Recommend every 5 years. Or a Cardiac CT Angiography (CCTA) - an injection of contrast dye with multiple X-ray images.
Bio-inflammatory-associated risk markers: homocysteine, omega-3’s/6’s, vitamin D, Insulin resistance, ferritin, and hs-crp. Routine in BBH work-up.
Lessons from Coaching:
Should I take a statin?
This month I’m turning the coaching question on me since this question comes close to home. Here’s how I made my decision.
The NOT-SO-GOOD news, aka my risk factors, are the following:
Age - I’m not getting any younger. Ha ha.
I am APOE4 Heterozygous - therefore my body hyperabsorbs cholesterol so despite my efforts to reduce saturated fat, which did drop my LDL-C by 20 points, it still is >150.
My APOB has been high - 120-130 for the past 8 years.
The GOOD News:
My recent second Calcium Score has remained “0”.
I don’t have hypertension, but my father did, so I keep my eye on it.
No insulin resistance and no diabetes.
I don’t have a Lipoprotein (a) - a genetic factor that increases ASCVD.
I’m not overweight.
I play pickleball 4 hours/week, and manage to add in line dance, bike ride, swim, walk with friends, and strength train.
The reality according to Tom Dayspring MD, Peter Attia’s Lipidologist, is that sooner or later those APOB proteins floating around in my arteries will bang against the artery wall and cause little tears in the endothelium, which begins the process of laying down plaque and atherosclerosis is born. Those problems can eventually lead to changes in not only vessels in my heart but my brain too. And you all know that my noggin is my major concern.
Finally, my PCP used the ASCVD Risk Calculator to figure out my risk of a stroke or heart attack over the next 10 years. It showed moderate risk. Honestly, with all my good news health practices, I was surprised. So what did I choose to do? I started a statin.
What is the best statin depends on many factors:
These are all important to discuss with your healthcare provider. What my healthcare provider and I didn’t know about was a blood test for a substance called Desmosterol. This is a form of cholesterol that is used in the brain. If this drops below 20% of normal, it could portent cognitive slowing, according to Tom Dayspring. I went ahead and obtained a Desmosterol level before going on a statin. Statins are water-soluble or fat-soluble. The fat-soluble ones cross the blood-brain barrier and can decrease Desmosterol in the brain. The water-soluble types do not. Finally, grapefruit juice can cause a drug-drug interaction with mostly fat-soluble statins and less so with water-soluble statins. Drug solubility may be a consideration when deciding on statin therapy. Water-soluble ones may cause fewer side effects than fat-soluble statins.
If you decide to take a statin remember to start low and go slow. I started 2 days a week, then to 3/week then by 8 weeks was at a full dosage. Remember to take them in the evening since cholesterol is produced by your body at night.
I offer coaching sessions to help navigate and improve brain health for you or a loved one. Contact me to schedule a session
Lessons from Science:
This one surprised me: Atherosclerotic plaques observed in fetuses: Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia.
How LDL contributes to heart disease, the world’s leading cause of death, and could open the door to personalizing LDL-lowering treatments like statins to make them even more effective.
Two cholesterol-lowering drugs could save more lives study suggests
To optimal health and peace for all!
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