Abstract WP122: Statins May Increase White Matter Hyperintensity Burden in Older Adults: A Systematic Review and Meta-Analysis

Abstract

Introduction: White matter hyperintensities (WMH) are a hallmark radiographic finding of cerebral microangiopathy. Longitudinal studies have shown varying effects of statins on accrual of WMH over time. We aimed to understand the impact of statins on WMH volume over time through a systematic review and meta-analysis. Methods: We performed a systematic review using standard search and risk of bias assessment practices. We included statin-exposed and statin-naive adults with longitudinal brain MRIs with computer-generated WMH volumetric analyses. The primary outcome was change in WMH volume (mL). Allowing for curvilinear change, a mixed-effects model was applied to capture the dynamic change over time. Model forecasts were used to visualize results, comparing changes over time among younger cohorts (60 years) and older cohorts (75 years) based on the the cohort mean age standard deviation. A p value ≤ 0.05 was considered significant. Results: We identified 6 studies enrolling 1911 participants from China, Europe, and North America (2 studies each); mean age 67.5 (± 7.5). The maximal study duration was 60-months. All studies had a least some degree of bias. Control groups had steady increase in WMH volume over time, Figures. The younger statin-exposed cohort developed statistically less WMH after 40 months of use. Older statin exposed patients had an increase in WMH volume compared with naïve patients which remained over the study duration. Conclusion: The impact of statins on WMH volume may be age dependent whereby older patients may have an accelerated accumulation. Further studies are warranted to confirm this data and investigate underlying mechanisms leading to this finding.