By AMERICAN HEART ASSOCIATION NEWS
NEW ORLEANS — A new study shows that using medications to lower blood pressure and cholesterol does not slow cognitive decline — disappointing news for millions of aging Americans eager to stave off thinking and memory problems.
But what didn’t help cognition also didn’t hurt it — big news considering the Food and Drug Administration slapped a warning on cholesterol-lowering statins in 2012, cautioning consumers about potential memory loss and confusion.
The new findings, however, add to growing evidence that statins do not pose a risk to brainpower, said lead investigator Jackie Bosch, Ph.D., who presented the findings Sunday at the American Heart Association’s Scientific Sessions.
“We can confidently say, you don’t need to be concerned about taking statins,” said Bosch, a researcher and associate professor at McMaster University in Canada.
About one in four Americans age 40 and older takes a statin, according to the Centers for Disease Control and Prevention. Statins — which include the popular brand names Crestor, Lipitor and Zocor — work by preventing the formation of bad LDL cholesterol.
Bosch hopes this latest evidence convinces the FDA to drop the cognitive effects warning from statin labels, a move medical experts already called for two months ago in a review study published in The Lancet.
“The short-term memory loss was only evident from observational studies and the data weren’t consistent. Yet the FDA put this warning on,” Bosch said.
Even so, the mental fog is a possibility, albeit rare, said neurologist Philip Gorelick, M.D., who has seen the effects in his own patients.
“It’s a real issue, but it’s probably a small subgroup of people,” said Gorelick, medical director of Mercy Health Hauenstein Neuroscience Center in Grand Rapids, Michigan, who was not involved in the study.
Called HOPE-3, the study included about 1,600 people at moderate risk for cardiovascular disease. They had risk factors such as abdominal obesity, smoking, diabetes or high blood pressure that was under control. The patients were at least 70 years old and received either the blood pressure drug candesartan/hydrochlorothiazide, the statin rosuvastatin, a combination of the two drugs, or a placebo.
Five and a half years later, every group — including those on the statin drug — had roughly the same declines in processing speed, reaction time and executive functions such as attention and decision-making.
“We’re going to use statin agents because they can have a tremendous benefit,” Gorelick said. “They reduce cardiovascular disease, they reduce stroke risk. Now this study provides some reassurance that rosuvastatin is safe [for the brain].”
The cardiovascular consequences of high blood pressure and high cholesterol, namely heart attacks and strokes, are well-known. But the conditions, particularly high blood pressure in middle age, can also be detrimental to the brain. Hypertension can damage arteries, cause inflammation and can even shrink the brain.
“People know high blood pressure can lead to stroke. They fear that relationship, but they don’t worry about having cognitive decline associated with it,” Bosch said.
An estimated 80 million U.S. adults have high blood pressure and nearly half of them do not have it under control, according to statistics from the American Heart Association. The association warned in a scientific statement released in October that high blood pressure is strongly linked to dementia, including Alzheimer’s disease, later in life.
“You can’t wait to treat high blood pressure,” said Gorelick, who helped write the statement and is a member of a recently formed AHA task force on brain health and healthy aging.
Clinical trials, however, have not shown that treating high blood pressure with medications or lifestyle changes can prevent cognitive decline. Even so, controlling hypertension and other cardiovascular risk factors topped the list of recommendations issued last April by the Institute of Medicine for keeping the brain healthy.
The issue has taken on urgency as the number of cases of dementia, which currently affects 30 million to 40 million people worldwide, is set to triple by 2050.
Experts hope an ongoing study called SPRINT-MIND will provide some useful data. The trial is testing whether lowering high blood pressure to a steeper target of 120, as opposed to the traditionally accepted 140, helps keep the mind sharp. Results are expected by the end of 2018.
“One of the biggest concerns for people as they age is cognitive decline,” Bosch said. “We didn’t see any effect, but could longer-term treatment help? It might, and it can’t hurt you.”