Prestroke Statins, Progression of White Matter Hyperintensities, and Cognitive Decline in Stroke Patients with Confluent White Matter Hyperintensities

Abstract

Cerebral white matter hyperintensities (WMH) are a consequence of cerebral small vessel disease. Statins have been shown to reduce recurrent stroke among patients with various stroke subtypes, including lacunar stroke, which also arises from small vessel disease. In this study, we investigated the hypothesis that prestroke statin use would reduce the progression of WMH and/or cognitive decline among stroke patients with confluent WMH. Patients (n=100) were participants of the VITAmins To Prevent Stroke magnetic resonance imaging substudy. All patients had confluent WMH on magnetic resonance imaging at baseline. Eighty-one patients completed the 2-year follow-up. We assessed general cognition and executive function using the mini-mental state examination and Mattis dementia rating scale-initiation/perseveration subscale, respectively. We compared the change in volume of WMH and cognition between prestroke statin use and prestroke nonstatin use groups. We also evaluated the effects of prestroke statin use on incident lacunes and microbleeds. The prestroke statin use group (n=51) had less WMH volume progression (1.54±4.52 cm 3 vs 5.01±6.00 cm 3 , p=0.02) compared with the prestroke nonstatin use group (n=30). Multivariate linear regression modeling identified prestroke statin use as an independent predictor of WMH progression (β=-0.31, p=0.008). Prestroke statin use was also associated with less decline (Mattis dementia rating scale-initiation/ perseveration subscale; β=0.47, p=0.001). No association was observed with changes in mini-mental state examination scores. There were no between group differences on incident lacunes or incident microbleeds. Prestroke statin use may reduce WMH progression and decline in executive function in stroke patients with confluent WMH.

White Matter Hyperintensities in Older Adults and Motoric Cognitive Risk Syndrome

“…This study also found that BMI was significantly associated with MCR in the French cohort, as demonstrated in previous work [3]. The prevalence of WMH was also consistent with previous studies [14, 22, 24, 39–44]. However, the French cohort did have a higher prevalence of WMH overall.…”

Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…124 For statin treatment, trials have provided conflicting evidence as to whether statin treatment reduces WMH progression. [125][126][127] Intensive glucose-lowering therapy in patients with type 2 diabetes mellitus did not reduce WMH progression and in fact was associated with higher WMH progression for unclear reasons. 128 Vitamin B and folate therapy did not reduce the progression of WMH in the VITATOPS study (Vitamins to Prevent Stroke), although a significant reduction in WMH progression (0.3 versus 1.7 cm 3 ; P=0.04) was detected in patients with severe WMH at baseline.…”

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

“…Vascular preventive therapy primarily reduces acute vascular events, for example, stroke and myocardial infarction,11 but may also limit chronic vascular damage. Following stroke, statins reduced white matter hyperintensity progression rates, and limited the decline in executive function 34. In AD, observational data suggested that treating vascular risk factors altered the rate of cognitive decline, although one can argue such studies are subject to bias 35.…”