Abstract
BackgroundStatins 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.MethodsWe 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.ResultsThe 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).ConclusionsOur 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 registrationChictr.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.
Highlights
Statins have been recommended by several guidelines as the primary prevention medication for cardiovascular diseases
Some prominent features associated with cerebral small vessel disease (CSVD) include white matter hyperintensities (WMH), lacunes, enlarged perivascular space (EPVS), and microbleeds observed through magnetic resonance imaging (MRI) [5, 6]
The WMH volume, WMH-to-intracranial volume (ICV) ratio, prevalence of a Fazekas scale score ≥ 2, lacunes, EPVS, and microbleeds were significantly lower in the statin group than the non-statin group
Summary
Statins have been recommended by several guidelines as the primary prevention medication for cardiovascular diseases. The benefits of statin therapy for cerebral small vessel disease (CSVD), in adults ≥75 years of age, have not been fully evaluated. CSVD is strongly associated with cardiovascular risk factors including hypertension, hyperlipidemia, and aging [1, 9,10,11]. The results of the Rotterdam Scan Study have demonstrated that blood pressure is not associated with WMH progression and incident lacunar infarcts in the oldest people [12]. The interaction between blood pressure and age in relation to WMH progression and incident lacunar infarcts is not statistically significant [12]. Blood pressure in the progression of CSVD may differ with age, and antihypertensive therapy may not ameliorate the progression of CSVD in the oldest people. Does lipidlowering treatment slow the progression of CSVD in the oldest people?
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
