In ALS, statin use not related to patient survival, study finds
Results suggest no need to routinely stop cholesterol medicine post-diagnosis
Taking statins to lower cholesterol does not affect survival outcomes for people with amyotrophic lateral sclerosis (ALS), researchers in Norway have found.
In a study of ALS patients using national health registry data, the scientists compared the life expectancy of statin users and nonusers.
According to the team, “statin use was not associated with ALS survival.”
The researchers noted that many people stop using statins prior to receiving an ALS diagnosis. This may be because early symptoms of ALS mimic common side effects of the medication, namely muscle pain and weakness.
These new findings “[suggest] that statin use should not routinely be discontinued upon diagnosis but rather be evaluated based on a patient’s overall clinical context,” the team wrote.
The study, “Statin Use and Amyotrophic Lateral Sclerosis Survival: A Population-Based Cohort Study,” was published in the European Journal of Neurology.
Statin use noted as ‘common concern’ in management of ALS
Among people with ALS, dyslipidemia — a condition in which cholesterol and other fatty molecules are seen at high levels in the bloodstream — is relatively common. Many individuals are prescribed cholesterol-lowering medications, such as statins, before they are diagnosed with ALS.
Regarding life expectancy, however, there is conflicting evidence about the impact of statin use on ALS survival rates. Some studies have reported a beneficial effect, while others have suggested a harmful effect, or indicated there is no clear correlation.
Nonetheless, “a widely used clinical guideline recommends discontinuing statins upon an ALS diagnosis,” the team noted. The scientists added that, “given that the risks of both cardiovascular disease and ALS increase with age, statin use is a common concern in ALS management.”
Now, the team, led by researchers at Akershus University Hospital, sought to determine if statin use and lower cholesterol were indeed linked to decreased survival among ALS patients. To that end, the researchers identified participants from four Norwegian studies of cardiovascular health that recorded cholesterol levels.
Using the personal identification numbers assigned to each Norwegian citizen, the researchers cross-referenced participants against three national databases: a patient registry, a prescription drug registry, and a cause of death registry. This combination of data allowed the team to identify 524 people who had cardiovascular health data recorded before a diagnosis of ALS.
Of this group, 194 took statins prior to diagnosis, while 330 never received prescriptions for the medication. Looking at the age at ALS diagnosis, statin users were older with a mean age of 68.8 years; nonusers had a mean age of 66 at diagnosis.
High cholesterol prediagnosis not seen to impact postdiagnosis life expectancy
The mean time from ALS diagnosis to death or the end of the study was two years.
After accounting for age disparity, treatment with the ALS therapy riluzole (approved in the U.S. under several brand names, depending on their formulation, and also as generics) and other risk factors such as sex and smoking status, there was no statistically significant difference in survival rates after diagnosis between statin users and nonusers, the researchers found.
We [further] found no association between total cholesterol measured several years prior to ALS diagnosis and ALS survival.
Importantly, per the researchers, the patients’ prediagnosis cholesterol levels were taken into account in this analysis. Because statins are prescribed to lower cholesterol, those who took statins had significantly higher cholesterol levels than the individuals who did not. With this adjustment, the analysis could separate the effects of statin use and the effects of high cholesterol.
These results showed that, like statin use, high cholesterol prediagnosis did not impact postdiagnosis life expectancy.
“We found no association between total cholesterol measured several years prior to ALS diagnosis and ALS survival,” the team wrote.
The researchers further compared patients with statin prescriptions with a control group of statin users without ALS, who were matched by sex and age with those with the disease. In this control group, fewer than 5% of people stopped using statins each year. This was similar in people with ALS until the year before being diagnosed with the disease, when 21% discontinued statin use.
This trend was “possibly due to early disease manifestations mimicking statin side effects,” the researchers hypothesized.
“In the absence of relevant randomized controlled trials, this cohort study serves an important role in suggesting that statin use does not affect ALS survival,” the researchers wrote.
Taken together, the findings warrant a reexamination of the current clinical practice of stopping statin use among people diagnosed with ALS, according to the team.
