Reframing Statins and Brain Health Around Stroke Prevention

In an interview with Pharmacy Times, Anum Saeed, MD, a cardiologist, lipidologist, and assistant professor of medicine at the University of Pittsburgh Medical Center (UPMC), explained how pharmacists and clinicians can respond to patient concerns about statins and brain health, building on her presentation at the National Lipid Association (NLA) 2026 Fall Clinical Lipid Update.

Saeed noted that pharmacists are patient-facing virtually all the time and are the medication experts, positioning them to reassure patients that about 20-plus randomized controlled trials examining statins and cognitive or dementia outcomes have not shown statistically significant harm. Although some Mendelian randomization data have suggested a possible small signal on reaction time and cognition, most of these findings were not statistically significant after multivariable adjustment. If a true harmful effect existed, Saeed said, it likely would have been seen by now, and the PREVENTABLE study (NCT04262206) is expected to provide adjudicated events.

To reframe the conversation, Saeed emphasized that statins and other lipid-lowering therapies have strong randomized evidence for reducing stroke and that vascular and post-stroke dementia are major contributors to dementia risk. Preventing stroke, she said, protects the brain. She also pointed to the EBBINGHAUS study (NCT02207634) of proprotein convertase subtilisin kexin type 9 inhibitors, in which patients reaching very low low-density lipoprotein cholesterol levels showed no statistically significant adverse cognitive effects, including in the open-label extension.

When counseling, Saeed validates patients' concern that the brain needs cholesterol, then explains that the brain makes its own cholesterol and is largely walled off by the blood-brain barrier, with little exchange with the peripheral circulation. She then reviews the data and emphasizes that preventing heart attacks and strokes supports overall longevity.

Saeed closed by stressing strong clinician-patient communication and outlining habits that support long-term brain health: cholesterol targets from the American Heart Association, American College of Cardiology, and NLA; blood pressure control; exercise; not smoking; 7 to 8 hours of sleep; positive social connections; education; and purposeful activities, ideally started early.