To access this material please log in or register

Register Authorize

Effects of High-Dose Statin Therapy on Cognitive Functions and Quality of Life in Very High Cardiovascular Risk Patients

Kobalava Zh. D., Villevalde S. V., Vorobyeva M. A.
RUDN University, Moscow, Russia

Keywords: statins; intensive statin therapy; cognitive functions; quality of life

DOI: 10.18087/cardio.2017.9.10024

Aim. To investigate the effects of intensive lipid-lowering therapy on cognitive functions and quality of life in patients (pts) with very high cardiovascular risk.

Material and methods.
In 93 pts (58 men, 63.2±9.5 years old with history of clinically evident cardiovascular disease and fasting low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/l or non-high-density lipoprotein cholesterol (non-HDL-C) >2.6 mmol/l the mental status and quality of life were assessed before and after 6 months of therapy with atorvastatin 80 mg/day. The Montreal Cognitive Assessment (MoCA) scale and Questionnaire SF-36 (russian version) were used to evaluate cognitive functions and quality of life.

59 (63%) pts had cognitive dysfunction (less than 26 scores by MoCA scale). We observed significant difference in cognitive status between pts ≥65 and <65 years (21.1±3.3 vs 25.6±1.8 points, p<0.05) and between pts with and without stroke (22.4±3.1 vs 24.7±2.78 points, p<0.05). Changes of cognitive function were insignificant in all groups. We observed improvement of mean scores in all sections of SF-36 except vitality: physical functioning (PF) from 57.3±26.7 to 62.9±23.4 points, role-physical functioning (RP) from 40.0±27.9 to 47.1±26.2, bodily pain (BP) from 58.9±30.1 to 70.3±25.4, general health (GH) from 51.9±13.6 to 57.4±14.1, social functioning (SF) from 62.5±23.1 to 70.3±25.4 points, role-emotional (RE) from 53.3±39.4 to 61.4±33.1, mental health (MH) from 66.4±15.1 to 71.3±18.2 points (p<0.05 for all trends). Values of PF, RP, GH and RE grew more in <65 years group.

63% of patients with high cardiovascular risk had cognitive impairment. No association between statin use and cognition was found. Intensive lipid-lowering therapy was association significant improvement of quality of life according to SF-36.
  1. Kuharchuk V. V., Konovalov G. A., Galjavich A. S. et al. Diagnostics and correction of dyslipidaemias in the prevention and treatment of atherosclerosis. Russian recommendations. Revision V. Ateroskleroz i dislipidemii 2012;4:5–61. Russian (Кухарчук В. В., Коновалов Г. А., Галявич А. С. и др. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации. V пересмотр. Атеросклероз и дислипидемии 2012;4:5–61).
  2. Catapano A.L., De Backer G., Wiklund O. et al. ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. Advance Access published August 27, 2016. doi:10.1093/eurheartj/ehw272. http://eurheartj.oxfordjournals.org/content/early/ 2016/08/26/eur-heartj.ehw272.
  3. Stone N.J., Robinson J.G., Lichtenstein A.H. et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129: S1 – S45. doi: 10.1161/01.cir.0000437738.63853.7a.
  4. Cholesterol Treatment Trialists’ (CTT) Collaboration. Baigent C., Blackwell L., Emberson J. et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670–81. doi: 10.1016/S0140–6736(10)61350–5.
  5. King D.S., Wilburn A.J., Wofford M.R. et al. Cognitive impairment associated with atorvastatin and simvastatin. Pharmacotherapy 2003;23 (12):1663–1667.
  6. Parker B.A., Polk D.M., Rabdiya V. et al. Changes in memory function and neuronal activation associated with atorvastatin therapy. Pharmacotherapy 2010;30 (6):236e – 40e.
  7. US Food and Drug Administration. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs 2012. http://www.fda.gov/Drugs/DrugSafety/ucm293101.htm.
  8. Brass L.M., Alberts M.J., Sparks L. An assessment of statin safety by neurologists. Am J Cardiol 2006;97 (8A): 86С-88С. DOI: 10.1016/j.amjcard.2005.12.017
  9. Bettermann K., Arnold A.M., Williamson J. et al. Statins, risk of dementia, and cognitive function: secondary analysis of the gink-go evaluation of memory study. J Stroke Cerebrovasc Dis 2011; 21 (6):436–444. doi: 10.1016/j.jstrokecerebrovasdis.2010.11.002.
  10. Muldoon M.F., Rossouw J.E., Manuck S.B., et al. Low or lowered cholesterol and risk of death from suicide and trauma. Metabolism 1993;42:45–56.
  11. You H., Lu W., Zhao S. et al. The relationship between statins and depression: a review of the literature. Expert Opin Pharmacother 2013;14:1467–1476. doi: 10.1517/14656566.2013.803067.
  12. O’Neil A., Sanna L., Redlich C., et al. The impact of statins on psychological wellbeing: a systematic review and meta-analysis. BMC Med 2012;10:154. doi: 10.1186/1741-7015-10-154.
  13. While A., Keen L. The effects of statins on mood: a review of the lite-rature. Eur J Cardiovasc Nurs 2012;11:85–96. doi: 10.1016/j.ejcnurse.2010.08.008.
  14. Golomb B.A., Evans M.A., Dimsdale J.E., et al. Effects of statins on energy and fatigue with exertion: results from a randomized controlled trial. Arch Intern Med 2012;172:1180–1182. doi: 10.1001/archinternmed.2012.2171.
  15. Mikus C.R., Boyle L.J., Borengasser S.J., et al. Simvastatin impairs exercise training adaptation. J Am Coll Cardiol 2013;62:709–714. doi: 10.1016/j.jacc.2013.02.074.
  16. http://newpsyhelp.ru/files/MoCA/MoCA.pdf
  17. Инструкция по обработке данных, полученных с помощью опросника SF-36. http://therapy.irkutsk.ru/doc/sf36a.pdf
  18. Permission for questionnaire SF-36 use. OPTUMINSIGHT NON-COMMERCIAL LICENSE. Lic.No: SLA QM0380024-CT183072-OP057524. https://campaign.optum.com/content/optum/en.html
  19. Orsi A., Sherman O., Woldeselassie Z. Simvastatin-associated memory loss. Pharmacotherapy 2001;21 (6):767–769.
  20. Ott B.R., Daiello L.A., Dahabreh I.J. et al. Do statins impair cognition? A systematic review and meta-analysis of randomized controlled trials. J Gen Intern Med 2015;30 (3):348–358. doi: 10.1007/s11606-014-3115-3.
  21. Beydoun M.A., Beason-Held L.L., Kitner-Triolo M.H. et al. Statins and serum cholesterol’s associations with incident dementia and mild cognitive impairment. J Epidemiol Community Health 2011;65 (11):949–957. doi: 10.1136/jech.2009.100826.
  22. Trompet S., van Vliet P., de Craen A.J. et al. Pravastatin and cognitive function in the elderly. Results of the PROSPER study. J Neurol 2010;257 (1):85–90. doi: 10.1007/s00415-009-5271-7.
  23. Summers M.J., Oliver K.R., Coombes J.S. et al. Effect of atorvastatin on cognitive function in patients from the Lipid Lowering and Onset of Renal Disease (LORD) trial. Pharmacotherapy 2007;27 (2):183–190. 10.1592/phco.27.2.183
  24. Macedo A.F., Taylor F.C., Casas J.P. et al. Unintended effects of statins from observational studies in the general population: systematic review and meta-analysis. BMC Med 2014;12 (1):51. doi: 10.1186/1741-7015-12-51.
  25. Rojas-Fernandes C.H., Goldstein L.B., Levey A.I. et al. An assessment by the Statin Cognitive Safety Task Force: 2014 update. J Clin Lipidol 2014;8: S5 – S16. doi: 10.1016/j.jacl.2014.02.013.
  26. Swiger K.J., Manalac R.J., Blumenthal R.S. et al. Statins and cognition: a systematic review and meta-analysis of short- and long-term cognitive effects. Mayo Clin Proc 2013;88 (11):1213–1221. doi: 10.1016/j.mayocp.2013.07.013.
  27. Okifuji A., Hare B.D. The association between chronic pain and obesity. J Pain Res 2015;8:399–408. doi: 10.2147/JPR.S55598.
Kobalava Zh. D., Villevalde S. V., Vorobyeva M. A. Effects of High-Dose Statin Therapy on Cognitive Functions and Quality of Life in Very High Cardiovascular Risk Patients. Kardiologiia 2017;57(9):34–41.

To access this material please log in or register

Register Authorize
Ru En