Abstract
Objectives
To investigate the effect of low-dose statins and apolipoprotein E (APOE) genotypes on cerebral small vessel disease (CSVD) to prevent CSVD in older hypertensive
patients.
Design
A subgroup analysis of a randomized clinical trial.
Setting
Shandong area, China.
Participants
Hypertensive patients aged ≥60 years were recruited from April 2008 to November 2010.
Measurements
Patients were randomly assigned to rosuvastatin (10 mg/day) or placebo groups. APOE genotypes were categorized as ε4 carriers and non-ε4 carriers. White matter hyperintensities (WMH), Fazekas scale, lacunes, and microbleeds
were assessed.
Results
After an average of intervention period of 61.8 months, WMH volume increased 1.45 ± 0.52 mL.
There were 107 new-incident Fazekas scale ≥2, 65 new-incident lacunes, and 63 new-incident
microbleeds. The increase in WMH volume was significantly lower in the rosuvastatin
group than in the placebo group and was higher in APOE ε4 carriers than in non-ε4 carriers (all adjusted P < .001). The risk of new-incident Fazekas scale ≥2 was higher in the placebo group
than in the rosuvastatin group (hazard ratio 2.150, 95% confidence interval 1.443–3.203;
P < .001). APOE ε4 carriers were associated with an increased risk of new-incident Fazekas scale ≥2
compared with non-ε4 carriers (hazard ratio 1.973, 95% confidence interval 1.334−2.920; P = .001). There were no statistically significant differences in the risk of new-incident
cerebral microbleeds between the rosuvastatin and placebo groups or between APOE ε4 carriers and non-ε4 carriers. There were no significant interactions between rosuvastatin use and APOE ε4 status regarding increased WMH volume (F = 1.020, P = .313) or for new-incident Fazekas scale ≥2 (P = .377), lacunes (P = .232), and microbleeds (P = .362).
Conclusions/Implications
Low-dose rosuvastatin is an effective and safe therapy for CSVD. The presence of APOE ε4 allele may not be able to predict rosuvastatin treatment outcomes for preventing
and/or treating CSVD in older hypertensive patients.
Keywords
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Article info
Publication history
Published online: July 10, 2018
Footnotes
This work was supported by the National Natural Science Foundation of China (grant numbers 81670432, 81470489, and 81500232); Natural Science Foundation of Shandong Province, China (grant numbers ZR2014HM098 and ZR2016HM82); the Key Research and Development Project of Shandong Province (grant numbers 2018GSF118044 and 2017GSF218060); and The Innovation Project of Shandong Academy of Medical Sciences.
The authors declare no conflicts of interest.
Role of the Funding Source: The funders of the study had no role in study design or implementation, data collection, analysis, interpretation, or writing and reviewing the report. The corresponding author and data analyst had full access to all study data and had final responsibility for the decision to submit for publication.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
