Certain Cholesterol-Lowering Statins May Decrease Risk of ALS, Large Medicare-based Study Suggests

Use of statins, the blood cholesterol-lowering medications, for more than a year was linked to a lower risk of developing amyotrophic lateral sclerosis (ALS) among older adults, a large Medicare beneficiaries-based study suggests.

The study “Relationship of statins and other cholesterol- lowering medications and risk of amyotrophic lateral sclerosis in the US elderly” was published in the journal Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration.

Statins are widely prescribed blood cholesterol-lowering medications. Some reports have suggested that their use may be linked with an increased risk for ALS. However, other studies found no association between statins and ALS.

Researchers at the National Cancer Institute and colleagues elsewhere evaluated the link between ALS risk and statin use in Medicare-registered ALS patients across the U.S. from 2006–2014.

In total, during the eight-year period, researchers identified 10,450 individuals diagnosed with ALS, median age 74 years and 51% were women. They included age and sex-matched controls, totaling 104,500 individuals.

Among the ALS patients and controls, 46.6% and 48.6% of them were using statins, respectively. The overall use of statins was linked with a lower risk for ALS.

“The risk of ALS was 13% lower among those prescribed statin drugs more than one year before an ALS diagnosis,” researchers wrote.

Other cholesterol-lowering medications that are not statins, namely niacin, bile acid sequestrates, and ezetimibe, had no link in ALS risk. Only one of these types of medications, called fibrates, was also linked with a lower risk of ALS.

The ALS risk decreased with increased duration of statin use for any statins, and specifically with lipophilic statins. Moreover, lipophilics — which include simvastatin, fluvastatin, lovastatin, pitavastatin — lowered the risk even in individuals with no abnormal fats (lipids) in the blood.

Statins are classified into hydrophilic and lipophilic groups based on tissue selectivity. Hydrophilic (including pravastatin, rosuvastatin)
 statins are liver specific, whereas lipophilic statins are widely distributed in different tissues.

Overall, “in this nationwide, population-based study we observed a lower ALS risk associated with statins and offer new evidence that fibrates may be related to reduced risk,” researchers wrote.

“It would be informative to evaluate these relationships in other databases with wider age ranges, longer follow-up, more detailed information on covariates, and lipid measurements,” the study concluded.