Abstract
Objective To investigate whether there is an association between cholesterol-lowering medication use, specifically statins, and chronic polyneuropathy.
Methods A literature study was carried out to assess the current state of evidence on the association between chronic polyneuropathy and cholesterol-lowering medication use. We also conducted a prospective case-control study to compare exposure to cholesterol-lowering medication between patients with cryptogenic axonal polyneuropathy and controls prior to the index date (defined in patients as date of onset of polyneuropathy symptoms, in controls as date of first study survey). Outcomes were adjusted for potential confounders such as cardiovascular history and metabolic syndrome.
Results The 13 studies identified in our literature search showed conflicting results (odds ratios [ORs] ranging from 0.66 to 14.2), but most studies had methodologic limitations. There was insufficient evidence that statin use is a risk factor for polyneuropathy. Our prospective case-control study included 333 patients with cryptogenic axonal polyneuropathy and 283 controls. Patients with polyneuropathy were less likely to have been exposed to statins than controls (OR 0.56, 95% confidence interval 0.34–0.95, p = 0.03). The odds of polyneuropathy decreased as exposure duration to statins increased. Cholesterol-lowering medication consisted almost exclusively of statins; therefore we only draw conclusions on the effect of statin use.
Conclusions Statin use does not increase the risk of chronic polyneuropathy. Therefore, statins should not be routinely withheld from polyneuropathy patients.
Classification of evidence This study provides Class III evidence that statin use does not increase the risk of polyneuropathy.
Glossary
- ATP-III=
- Adult Treatment Panel III;
- BMI=
- body mass index;
- CI=
- confidence interval;
- DDD=
- defined daily dosage;
- ICD=
- International Classification of Diseases;
- OR=
- odds ratio;
- PAN=
- population-based amyotrophic lateral sclerosis study in the Netherlands;
- UMCU=
- University Medical Center Utrecht
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Class of Evidence: NPub.org/coe
- Received July 20, 2018.
- Accepted in final form December 17, 2018.
- © 2019 American Academy of Neurology
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