Serum low-density lipoprotein levels, statin use, and cognition in patients with coronary artery disease

Abstract

AimStatins have been associated with decreased cognition due to the effects of low concentrations of low-density lipoprotein (LDL) on brain function. This has remained controversial and is particularly relevant to patients with coronary artery disease (CAD), who have an increased risk of cognitive decline and are frequently prescribed statins. This study hypothesized that low concentration of LDL is associated with poor cognition in CAD patients using statins. It also explored the association between high-dose versus low-dose statins on cognition in this population.Patients and methodsBaseline cross-sectional data from a longitudinal study of 120 statin-using CAD patients were examined (mean statin duration 25±43 months). The main outcomes were measures of global cognition and cognitive domains, with poor cognition defined as cognitive performance ≤1 standard deviation below the population age and education adjusted means. A battery of cognitive tests was used to assess verbal memory, executive function, speed of processing, visuospatial memory, and global cognition. Adjusting for age, sex, education, and other covariates, multivariable logistic regression analyses assessed associations between low LDL levels (<1.5 mmol/L), statin use, and poor cognition.ResultsLDL levels were not associated with global cognition or individual cognitive domains. High-dose statin use was associated with higher visuospatial memory (odds ratio, OR [95% confidence interval, CI] =0.12 [0.02–0.66], P=0.01) and executive functioning (OR =0.25 [0.06–0.99], P=0.05). This effect was independent of covariates such as LDL levels.ConclusionLow LDL levels do not appear to be associated with poor cognition in CAD patients using statins. Whether high-dose statin use may have positive effects on cognition in CAD patients could be investigated in future studies.

Cognitive function in patients with coronary artery disease: A literature review

“… 29 – 31 Study samples ranged from 17 to 4752 patients with a median number of 101 participants. Eleven studies were described as cross-sectional studies, 31 – 41 eight were comparative studies, 42 – 49 five were randomized controlled trials, 50 – 54 and two were retrospective cohort studies. 30 , 55 The remaining studies were a prospective cohort study, 29 an observational study, 27 a follow-up study, 28 a case-control study, 56 a longitudinal study, 57 and an interventional study.…”

“…The tests used to examine the executive domain of cognitive function were the Trail Making Test, 29 , 31 , 34 – 41 , 48 , 50 , 51 , 54 , 55 , 58 Digit Symbol Substitution Test, 31 , 35 – 41 , 50 , 54 , 55 Digit Span Test, 31 , 36 , 39 , 42 , 43 , 49 , 51 – 53 , 55 and Controlled Oral Word Association Test. 29 , 31 , 35 , 37 , 38 , 43 , 45 , 51 , 54 Verbal memory was most commonly assessed using the California Verbal Learning Test. 35 , 37 , 38 , 40 , 41 , 54 The global cognitive function measure used in most of the studies was the Mini-Mental State Examination.…”

“… 29 , 31 , 35 , 37 , 38 , 43 , 45 , 51 , 54 Verbal memory was most commonly assessed using the California Verbal Learning Test. 35 , 37 , 38 , 40 , 41 , 54 The global cognitive function measure used in most of the studies was the Mini-Mental State Examination. 27 – 31 , 33 , 34 , 37 , 39 , 40 – 42 , 56…”

“… 29 – 31 , 36 , 37 , 47 , 54 , 57 , 59 However, most studies used the negative deviation from the z-score of the cognitive functioning tests. 27 , 34 , 35 , 38 , 41 , 44 , 45 , 49 , 51 , 55 , 58 Some studies focusing on CABG discussed their findings in light of postoperative cognitive decline (POCD), 27 , 28 , 42 – 46 , 52 , 58 while others did not address this issue. 47 , 50 , 51 , 53 , 59 …”

Analysis of utilization of medication from A02BA and A02BC group – results of the survey study among patients from community pharmacy

“…Najnowsze badania przeprowadzone u pacjentów z chorobą wieńcową wykazały, że obniżenie stężenia LDL (lipoproteiny o małej gęstości, low-density lipoprotein) do relatywnie niskiego poziomu (<1,5 mmol/L) nie wpływa negatywnie na pamięć. Co więcej, duże dawki statyn mogą usprawniać pamięć przestrzenną, szybkość przetwarzania informacji i funkcje wykonawcze u tych chorych [7]. Wg Toyama i wsp.…”