DEAR DR. ROACH: I appreciate you taking a holistic view on balancing the risks and benefits when prescribing statins. My question is, how does one balance this with an Alzheimer\u2019s patient?<\/p>\n
My father is 84 (he has already lived longer than both of his parents) and was diagnosed with early Alzheimer\u2019s this past September. (He has elevated levels of beta-amyloid and tau proteins, as well as memory issues.) He has some atherosclerotic issues and had a heart stent placed about a decade ago. His carotid arteries are less than 50% blocked. He is on atorvastatin, and his levels are considered to be \u201chigh normal.\u201d<\/p>\n
My concern is that the statin will accelerate his Alzheimer\u2019s. I wonder if an increase in his life expectancy might not be worth the risk of increasing his dementia. Or perhaps a different statin is a better option? He is still very active and does yard work regularly. — S.D.S.<\/p>\n
ANSWER: Recent research has suggested that lipophilic statins may worsen memory. Lipophilic statins — atorvastatin, simvastatin, lovastatin, fluvastatin and pitavastatin — can enter the brain and, in theory, cause symptoms like memory loss.<\/p>\n
In practice, the risk of developing dementia while on a statin may be lower than not being on a statin. But part of this is because statins protect against strokes, which is a common cause of dementia and can worsen Alzheimer\u2019s. When memory loss does occur on a lipohilic statin, it usually goes away when stopping the statin.<\/p>\n
For your father, whose test results are certainly suggestive of Alzheimer\u2019s, I can understand why you would want to avoid a lipophilic statin. The hydrophilic statins — pravastatin and rosuvastatin — have very few reports of memory loss. For this reason, as long as there are no insurance issues, I tend to use rosuvastatin as my first choice when I prescribe a statin to a patient.<\/p>\n
Rosuvastatin is about $10 per month, even without insurance, by using a coupon from GoodRx, and it\u2019s about $6 for a three-month supply at Cost Plus Drugs. The co-pays for many of my patients are higher than the cost of using these resources.<\/p>\n
With a person like your father who is actively enjoying life, doing everything reasonable to improve his quality of life is appropriate. This includes a healthy diet as well as a statin and aspirin in a person with coronary artery disease or with blockages in the main arteries to the brain.<\/p>\n
DEAR DR. ROACH: I am a 74-year-old man with no major health issues. Over the past several years, I have been getting a COVID booster in the spring with a second booster in the fall, as well as a flu shot. At my age, is it still appropriate to get a COVID booster in the spring? Also, after getting a respiratory syncytial virus (RSV) vaccination last fall, are annual boosters recommended? — R.W.<\/p>\n
ANSWER: I am recommending a COVID booster this spring for my highest-risk patients — those with immune system diseases and older people with heart or lung disease. For a healthy 74-year-old, the choice is yours. There is some benefit to getting the vaccine, but I wouldn\u2019t push a person who was reluctant to do so.<\/p>\n
We aren\u2019t sure yet how long the protection from the new RSV vaccine will last. At the current time, booster vaccines are not recommended.<\/p>\n
I am hopeful that the Advisory Committee on Immunization Practices (the Centers for Disease Control committee that develops vaccine recommendations) will be able to meet and provide clinicians like me with guidance on future doses of the RSV vaccines. An unbiased team of experts has been an invaluable resource.<\/p>\n