Two truths are self evident: 1) Parkinson’s disease is more common as
people age; 2) Vascular disease (such as heart disease and stroke) are also
more common as people age.
Fortunately, there is much that can be done to reduce a person’s risk
of having a stroke or heart attack. As well as exercise (yet another mention
for the miracle cure), there is a wide selection of medicines that have
excellent evidence of benefit.
In the UK, there have been two very large, very well conducted studies
of people with early stage PD – the Tracking Parkinson’s study (PRoBaND) and the
Oxford Discovery study. These studies give us an incredible opportunity to
discover subtle findings that you need observations of thousands of people.
In the attached paper, many of the leaders of the British Parkinson’s
disease field (including several professors from UCL) looked at the
relationship between Parkinson’s and vascular treatment.
They found that in nearly 3000 people from across the UK with early
stage PD, nearly 60% had increased risk of vascular disease, and yet only 1 in
4 of those people were having treatment for it.
Statins were designed as cholesterol lowering drugs. As they’ve been
widely used, it seems there are lots more beneficial properties to statins.
Such is the likelihood that they have a benefit to brain cells, there is a
study of statins in MS and statins in Parkinson's underway currently. (For more
information see this Queen Square
MS centre page, and the PD
STAT study site).
Whether or not statins work to protect the brain in humans remains to
be seen (return here for the answer when the studies are published). What is
clear is that if you have Parkinson’s, you should be asking your GP to assess
your heart health!
Do you think Statins will be part of the answer? Do you think we're joining the dots enough, either individually between specialists, GPs and people with Parkinson's, or as a research community? Let us know your thoughts. Join the discussion below.
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.
BACKGROUND:Cardiovascular disease (CVD) influences
phenotypic variation in Parkinson's disease (PD), and is usually an indication
for statin therapy. It is less clear whether cardiovascular risk factors
influence PD phenotype, and if statins are prescribed appropriately.
OBJECTIVES:To quantify vascular risk and statin use in
recent-onset PD, and examine the relationship between vascular risk, PD
severity and phenotype.
METHODS:Cardiovascular risk was quantified using the QRISK2
calculator (high ≥20%, medium ≥10 and <20%, low risk <10%). Motor
severity and phenotype were assessed using the Movement Disorder Society
Unified PD Rating Scale (UPDRS) and cognition by the Montreal cognitive
assessment.
RESULTS:In 2909 individuals with recent-onset PD, the mean
age was 67.5 years (SD 9.3), 63.5% were men and the mean disease duration was
1.3 years (SD 0.9). 33.8% of cases had high vascular risk, 28.7% medium risk,
and 22.3% low risk, while 15.2% of cases had established CVD. Increasing
vascular risk and CVD were associated with older age (p<0.001), worse motor
score (p<0.001), more cognitive impairment (p<0.001) and worse motor
phenotype (p=0.021). Statins were prescribed in 37.2% with high vascular risk,
15.1% with medium vascular risk and 6.5% with low vascular risk, which compared
with statin usage in 75.3% of those with CVD.
CONCLUSIONS:Over 60% of recent-onset PD patients have high
or medium cardiovascular risk (meriting statin usage), which is associated with
a worse motor and cognitive phenotype. Statins are underused in these patients,
compared with those with vascular disease, which is a missed opportunity for
preventive treatment.
TRIAL REGISTRATION NUMBER:GN11NE062, NCT02881099.
