DEAR DR. ROACH: I am a 74-year-old female who is 5 feet, 3 inches tall, and weighs 120 pounds. I live a healthy, active lifestyle. At age 59, during a regular doctor appointment, I was told that I had unknowingly had a heart attack. I had an angiogram, which showed no blockages. I was also given a nuclear imaging test to ascertain if there were any blockages in the smaller arteries to the heart. There were none. It was several weeks before I was cleared to resume physical exercise.
It was determined that I had suffered a coronary spasm (variant angina) that had induced the infarction. I saw a cardiologist for a few years, but I have had no issues or problems since. My doctors have prescribed 40 mg of atorvastatin daily for the past 15 years. My cholesterol is consistently about 180 mg/dL, with my HDL cholesterol near 75 mg/dL and my LDL near 90 mg/dL.
I have heard there is some evidence that statins can adversely affect dementia. What are your thoughts? — K.S.C.
ANSWER: Vasospastic angina, also called variant angina, is a cause of chest pain in both women and men due to low blood flow when the blood vessels to the heart constrict. Heart attacks often happen in combination with blockages in the arteries to the heart, but they can occur with no blockages at all.
The diagnosis is made when a spasm is seen during an angiogram in a person with angina and changes in their electrocardiogram. Management includes medication to prevent vasospasm, such as nitroglycerine and calcium blockers, as well as smoking cessation, if appropriate.
Statin drugs like atorvastatin have been proven to help prevent a coronary spasm, so it does help prevent symptoms (and another heart attack). It would be best for you to keep taking it, but I understand why you would be concerned if it really did increase the risk of dementia.
The relationship of statins and dementia can be confusing. Of the most common two types of dementia, vascular dementia and Alzheimer’s, statins play a clear role with the first, since they are indicated in people who have strokes with or without dementia as a result of the stroke, and they possibly play a helpful role with the second. Large studies have shown that people taking statins have a reduced risk of Alzheimer’s, although controlled trials have not confirmed this. Still, the empiric data shows significantly reduced dementia among statin users.
On the other hand, some people taking certain statins may have memory effects as a result of the statin. Although memory loss is not a common side effect, when it is reported, it’s almost always with “lipophilic” statins like atorvastatin and simvastatin. It’s almost never with “hydrophilic” statins like pravastatin and rosuvastatin. I tend to prescribe rosuvastatin preferentially because of this concern with new patients, but I do not change my patients who are doing well on atorvastatin.
So, while statins reduce overall dementia due to their beneficial effects on blood vessels, some people may experience memory loss with certain statins, which seems to be reversible by changing to a different statin. In a person with a clear indication for a statin, such as a person with a vasospastic angina, the benefits are very likely to outweigh the harms.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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