A study of statin use in the prevention of cognitive impairment of vascular origin in the UK

Abstract

Introduction There is increasing evidence suggesting that control of hypertension and antiplatelet therapy may prevent or reduce progression of vascular-related cognitive impairment (VCI), though a similar role of statins in this group of patients has yet to be established. Methods We conducted a postal survey of a group of 296 medical practitioners (comprising of physicians and psychiatrists specialising in the elderly, and general practitioners) inquiring into their management of (a) patients at high risk of developing VCI and (b) patients with established VCI. Results The overall response rate was 60% (177/296), with the highest response rate from psychiatrists. (a) For patients at high risk of developing VCI: 47% of clinicians believed that statins had an important role in preventing subsequent dementia: 4% would commence statins at a total cholesterol (TC) of 4–5 mmol/L; 38% with a TC of 5.1–6.5 mmol/L; and 32% with a TC of 6.6–8 mmol/L. Cardiovascular risk profile, age, cost and gender were other factors considered as important factors influencing statin prescription. (b) In those patients with established VCI: 32% of clinicians felt that statins had an important role in arresting progression, usually in people with a mild degree of cognitive impairment: 4% would commence statins at a TC of 4–5 mmol/L; 25% with a TC of 5.1–6.5 mmol/L; and 22% with a TC of 6.6–8 mmol/L. There were no major differences between clinicians in their prescribing habits. Conclusions A substantial proportion of clinicians favour the use of statins in primary and secondary prevention of cognitive impairment of vascular origin, despite a lack of definite evidence to support their use at the present time.