Many patients with recent-onset Parkinson’s disease have increased cardiovascular risk, but statin therapy is underused in this population, according to research published online ahead of print September 26 in the Journal of Neurology, Neurosurgery and Psychiatry. Increased cardiovascular risk is associated with greater motor and cognitive severity and greater axial impairment. Increased use of statins may reduce chronic vascular damage, and thereby slow the progression of motor and cognitive decline in this population, said the authors.
Cardiovascular disease influences phenotypic variation in Parkinson’s disease, but data are unclear about whether cardiovascular risk factors influence Parkinson’s disease phenotype, said Diane M. A. Swallow, MB, ChB, a clinical research fellow in movement disorders at Queen Elizabeth University Hospital in Glasgow. She and her colleagues studied prospectively enrolled participants in the UK Tracking Parkinson’s study and the Oxford Discovery study to quantify vascular risk and statin use in patients with recent-onset Parkinson’s disease. The investigators also sought to clarify the relationship between vascular risk and the severity and phenotype of Parkinson’s disease.
Cardiovascular risk was quantified using the QRISK2-2015 prediction algorithm, which computes risk based on traditional risk factors (eg, age, systolic blood pressure, smoking status, and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with BMI, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.
In all, 2,909 patients were analyzed. The population’s mean age was 67.5, mean disease duration was 1.3 years, and 65.3% of the sample was male. As calculated by the QRISK2-2015, 10-year cardiovascular risk was low for 22.3%, medium for 28.7%, and high for 33.8% of the sample, respectively. Statins were prescribed in 15.1% of patients with medium vascular risk and in 37.2% of patients with high vascular risk. In contrast, statins were prescribed in 75.3% of participants with established vascular disease.
Increasing vascular risk was associated with worsening scores on Part 3 of the Unified Parkinson’s Disease Rating Scale when adjusted for age, sex, disease duration, and coffee consumption. Increasing vascular risk was also associated with increasing cognitive impairment, a worsening score on the Montreal Cognitive Assessment (MoCA), and an increasing proportion of patients with mild cognitive impairment and dementia. The motor and cognitive characteristics of participants with high vascular risk were similar to those of participants with established vascular disease.
Among individuals with established vascular disease and a QRISK2 score of 10% or greater, people who were treated with statins were less likely to have the postural instability and gait difficulty subtype of Parkinson’s disease, but had lower total MoCA scores and were more likely to have cognitive impairment. Among patients with established cardiovascular disease, people treated with statins had better cognition, but did not significantly differ in their likelihood of having postural instability and gait difficulty.
“In assessing our findings, we need to consider that the patients are likely to have been recommended for statins based on their clinical findings, so we cannot compare these groups as if they had been randomized to statin therapy. It is clear that increased vascular risk adds to the burden of gait and cognitive impairment that we see in patients with Parkinson’s disease, and that this [risk] is undertreated,” said Dr. Swallow.
—Erik Greb
Suggested Reading
Swallow DM, Lawton MA, Grosset KA, et al. Statins are underused in recent-onset Parkinson’s disease with increased vascular risk: findings from the UK Tracking Parkinson’s and Oxford Parkinson’s Disease Centre (OPDC) discovery cohorts. J Neurol Neurosurg Psychiatry. 2016 Sep 26 [Epub ahead of print].