Lowering Cholesterol and Blood Pressure Among Elderly Does Not Prevent Cognitive Decline

What does prevent cognitive decline then? Specifics, not generalities.

Lowering Cholesterol and Blood Pressure Among Elderly Does Not Prevent Cognitive Decline

Lowering cholesterol and blood pressure in elderly patients offers no protective effect on cognitive decline, according to a cognition substudy of the phase 3 HOPE-3 trial, presented at the 2016 Annual Meeting of the American Heart Association (AHA).
“Dementia, vascular cognitive impairment, vascular dementia, and cognitive aging are some of the biggest concerns of our elderly and aging populations,” noted the AHA-appointed discussant for the trial, Ralph Sacco, MD, University of Miami Health System, Miami, Florida, speaking here at a Scientific Sessions 2016 press briefing here on November 13. “Unfortunately, we don’t have any treatments or approaches that actually alter that risk.”
In all, 3,086 subjects 70 years or older were recruited for the HOPE-3 trial, and answered questions relative to decline in processing speed (primary outcome: Digit Symbol Substitution Test [DSST]), executive function, psychomotor speed, functional changes and global activity.
Overall, HOPE-3 participants did experience cognitive and function decline over the 5.6 years of follow-up, noted lead author Jackie Bosch, PhD, McMaster University, Hamilton, Ontario, Canada. Blood-pressure lowering agents and rosuvastatin, however, did not significantly prevent cognitive or functional decline. Study-end DSST scores were similar for individuals receiving blood-pressure medications or placebo (P = .86), statin lowering with rosuvastatin or placebo (P = .38), and the combination of blood-pressure and cholesterol lowering versus double placebo (P = .63).
A post-hoc analysis among 93 patients revealed a positive trend toward reduced cognitive decline among in those who were in the highest tertile of blood pressure and LDL cholesterol at baseline (> 145 mm Hg/>140 mg/dL). Longer duration of blood-pressure lowering was also associated with less cognitive decline. “Both of these findings”, Dr. Bosch emphasised, “require further confirmation.”
Dr. Bosch underscored that rosuvastatin had no adverse effects on cognitive function. Anecdotal and observational studies, she said, have raised concerns that statins may adversely affect cognition, and have led to black box warnings in statin labeling.
Funding for this trial was provided by AstraZeneca and the Canadian Institutes of Health Research.
[Presentation title: The Effect of Blood Pressure and Cholesterol Lowering on Cognition.]