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
2016
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.
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