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To the Editor:
We read the interesting observational study of Cramer et al.1 regarding statin therapy and the incidence of cognitive impairment without dementia and dementia in an elderly Mexican-American population. The authors conclude that statin users are half as likely to develop cognitive impairment or dementia over the 5 years of observation. However, the study suggests that higher cholesterol levels actually protect subjects from cognitive impairment and dementia.
Baseline total cholesterol levels of statin-treated populations are higher than those of the general population.2 Presumably, the cholesterol levels of the statin-treated patients in this study were higher than those of the non-statin treated patients. In the Framingham Heart Study cohort, subjects with total cholesterol levels more than 200 mg/dL, compared to those with levels less than 200 mg/dL, performed significantly better in cognitive measures including word fluency, attention, and concentration. The observation period in that study predated the widespread use of statins.3
Moreover, an 8-year observational trial involving middle-aged women revealed that women with higher low-density lipoprotein (LDL) cholesterol levels had a significantly better memory.4 Interestingly, Cramer …
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