Abstract
Background and Objectives: The efficacy of hydroxy methyl glutaryl-coenzyme A reductase inhibitors (statins) in reducing the incidence of cardiovascular events pushed the target LDL-cholesterol (LDL-C) levels lower and lower in successive guidelines despite signals regarding potential cognitive side effects. We evaluated the relationship between cognitive impairment and LDL-C levels in elderly ischemic stroke patients. Materials and Methods: 29 ischemic stroke patients aged 65 and above with LDL-C levels ≤70 mg/dL, classified according to the TOAST criteria, underwent detailed neuropsychological testing comprising the MMSE test, Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Evaluation (ACE-III) test. Their performances were compared to those of 29 age-matched ischemic stroke patients with LDL-Cl levels >71 mg/dL. Results: The MMSE test failed to detect significant cognitive differences between the two groups. The MoCA and ACE-III tests detected impairments in visuo-spatial/executive function, attention, and recall/memory in patients with low LDL-C. A stepwise linear regression model of the ACE-III total scores revealed that LDL-cholesterol levels could contribute to 13.8% of the detected cognitive dysfunction, second in importance only to age, which contributed to 38.8% of the detected impairment. Conclusions: Physicians should be cautious when prescribing statins to elderly people. Hydrophilic ones may be preferred in cognitively impaired patients.
Highlights
IntroductionThe involvement of cholesterol in cardiovascular disease pathogenesis has been known since the second half of the 20th century, but the dietary measures and poorly tolerated available medications used to reduce cholesterol levels, such as cholestyramine and clofibrate, did not gain popularity among physicians [1].The release of the results of the Scandinavian Simvastatin Survival Study (4S) in1994 [2] followed by other studies reinforcing the beneficial effects of statins both in primary and secondary prevention of cardiovascular disease [3,4,5] changed these practices.In the past decades we witness a dramatic change in the management of dyslipidemia [6].The first Adult Treatment Panel for National Cholesterol Education Program (NCEPATP I) recommended in 1988 low-density cholesterol (LDL-C) target level of
A ≥50% LDL-C reduction from baseline in very-high-risk patients [8], a recommendation ranked as class I level of evidence A for secondary prevention and as class I level of evidence B in primary prevention, mentioning that older people should be treated in the same way as younger patients
The mean systolic blood pressure (BP) in the low LDL-C group was 150.62 +/− 22 mm Hg, while in the control group it was 160.76 +/− 22.9 mm Hg, with no statistical significance shown by the independent samples t-test
Summary
The involvement of cholesterol in cardiovascular disease pathogenesis has been known since the second half of the 20th century, but the dietary measures and poorly tolerated available medications used to reduce cholesterol levels, such as cholestyramine and clofibrate, did not gain popularity among physicians [1].The release of the results of the Scandinavian Simvastatin Survival Study (4S) in1994 [2] followed by other studies reinforcing the beneficial effects of statins both in primary and secondary prevention of cardiovascular disease [3,4,5] changed these practices.In the past decades we witness a dramatic change in the management of dyslipidemia [6].The first Adult Treatment Panel for National Cholesterol Education Program (NCEPATP I) recommended in 1988 low-density cholesterol (LDL-C) target level of
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