Journal Article

Assessing the effectiveness of statin therapy for alleviating cerebral small vessel disease progression in people ≥75 years of age

Gong, Gary, Liu, Xukui, Guo, Yuqi, Sun, Shangwen, Jia, Qing, Zhang, Hua, Liu, Zhendong, Li, Yunpeng, Zhao, Yingxin, Cui, Yi, Chai, Qiang

2020

Overview

Background Statins have been recommended by several guidelines as the primary prevention medication for cardiovascular diseases. However, the benefits of statin therapy for cerebral small vessel disease (CSVD), particularly in adults ≥75 years of age, have not been fully evaluated. Methods We analyzed the data from a prospective population-based cohort study and a randomized, double-blind, placebo-controlled clinical trial to determine whether statin therapy might aid in slowing the progression of CSVD in adults ≥75 years of age. For the cohort study, 827 participants were considered eligible and were included in the baseline analysis. Subsequently, 781 participants were included in follow-up analysis. For the clinical trial, 227 participants were considered eligible and were used in the baseline and follow-up analyses. Results The white matter hyperintensities (WMH) volume, the WMH-to-intracranial volume (ICV) ratio, the prevalence of a Fazekas scale score ≥ 2, lacunes, enlarged perivascular spaces (EPVS), and microbleeds were significantly lower in the statin group than the non-statin group at baseline in the cohort study (all P  < 0.05). During the follow-up period, in both the cohort and clinical trial studies, the WMH volume and WMH-to-ICV ratio were significantly lower in the statin/rosuvastatin group than the non-statin/placebo group (all P  < 0.001). Statin therapy was associated with lower risk of WMH, lacunes, and EPVS progression than the non-statin therapy group after adjustment for confounders (all P  < 0.05). There was no statistically significant difference in the risk of microbleeds between the statin and non-statin therapy groups (all, P  > 0.05). Conclusions Our findings indicated that statin therapy alleviated the progression of WMH, lacunes, and EPVS without elevating the risk of microbleeds. On the basis of the observed results, we concluded that statin therapy is an efficient and safe intervention for CSVD in adults ≥75 years of age. Trial registration Chictr.org.cn: ChiCTR-IOR-17013557 , date of trial retrospective registration November 27, 2017 and ChiCTR-EOC-017013598 , date of trial retrospective registration November 29, 2017.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Aged / Aging / Analysis / Antihypertensives / Blood pressure / Brain / Cardiovascular agents / Cardiovascular diseases / Cerebral small vessel disease / Cerebral Small Vessel Diseases - diagnostic imaging / Cerebral Small Vessel Diseases - drug therapy / Clinical trials / Cohort Studies / Dementia / Development and progression / Disease Progression / Drug therapy / Geriatrics / Geriatrics/Gerontology / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Hypertension / Magnetic Resonance Imaging / Medical research / Medicine / Medicine & Public Health / Neurology / Neuroprotection / Population studies / Prevention / Prospective Studies / Rehabilitation / Research Article / Retrospective Studies / Statins / Statistical analysis / stroke and cognition / Substantia alba / Vascular diseases