Abstract 337: Cognitive Function by Statin Exposure in Elderly Individuals Following Acute Myocardial Infarction
Introduction: There remain concerns about the safety of statin therapy in elderly individuals particularly their effects on cognitive function, which may limit their use after an acute myocardial infarction (AMI) despite beneficial effects on morbidity and mortality. We describe cognitive function after new initiation of statin among elderly patients following an AMI. Methods: Among AMI patients &gt;65 years of age in a US multicenter registry who were statin naïve, we examined the association between statin prescription at discharge and change in cognition (via Modified Telephone Interview for Cognitive Status [TICS-M]; scores range 0-50; higher scores indicate better cognitive function) assessed at 1 to 6 months after AMI. We conducted a non-inferiority test to evaluate the hypothesis that the mean change in cognitive function was no worse among statin naïve patients recently started on statins compared with those who were not. With the present sample size, we had &gt;85% power to demonstrate non-inferiority, using a threshold of 2.3 points on the TICS-M scale (10% of the mean1-month score). A hierarchical multivariable linear model examined the association between statin therapy and the change of TICS-M scores from 1 to 6 months. Results: Among 317 elderly AMI patients, 262 patients (83%) were prescribed a statin at discharge and 55 were not. There were no significant differences in 1-month (23 exposed vs 22 unexposed; p=0.35) or 6-month (23 exposed vs 22 unexposed; p=0.15) TICS-M scores (see Figure). Statin-exposed patients had an average increase in TICS-M scores from 1 to 6 months of 0.13 points vs. a decrease in score of 0.40 in the unexposed patients (p=0.53). After adjusting for age, education, CVA, HTN, GFR, in-hospital CABG, history of previous MI, depression, and GRACE score, there remained no significant effect of statin exposure on change in TICS-M (estimate 0.46, 95% CI: -1.25, 2.17; p=0.52). Conclusions: Among statin naïve elderly individuals recovering from an AMI, the initiation of statin therapy was not associated with detectable changes in short-term cognitive function. These findings support the general safety of statin therapy for secondary prevention in this population. Future studies are needed to confirm these findings.