Authors: Aniek M Van Gils, Julia HI Wiersinga, Sara AJ Van de Schraaf, Marijke C Trappenburg, Mike JL Peters, Hanneke FM Rhodius‐ Meester, Majon Muller
Published: 2020-12-07
DOI: 10.1002/alz.043472
Source: Full article
AbstractBackgroundDementia and cardiovascular disease(CVD) are closely linked and share common risk factors. High cholesterol levels are a major risk factor for CVD and lipid‐lowering drugs(LLD) have proven to reduce this risk but are also associated with multiple side effects. Frail older patients, among them patients with cognitive impairment, are possibly less likely to experience benefit from LLD due to shorter life‐expectancies. However, there is a lack of consensus whether to continue or withdraw LLD treatment in this patient group. In this study, we examined LLD prescribing patterns for older patients(frail/non‐frail, with/without CVD) at different levels of cognitive impairment.MethodWe included data of 271 memory clinic patients with a diagnosis of dementia(n=146), mild cognitive impairment(MCI,n=80) and subjective cognitive decline(SCD,n=55) from the Amsterdam Ageing Cohort(AAC); mean age was 80(±5) yrs, 49% was female. Prevalence of LLD use was assessed for patients with and without CVD and stratified according to age(≤80,>80yrs), polypharmacy(<5,5‐8,>8 drugs) and physical frailty(gait speed<0.8,≥0.8m/s). LDL‐c levels were measured; patients with an LDL‐c level<2.5mmol/L were considered ‘on‐target’.ResultIn patients with CVD, LLD use in SCD, MCI and dementia patients was 45%, 61% and 69%; 78‐90% of these patients were on‐target. In patients without CVD, LLD use in SCD, MCI and dementia patients was 20%, 41% and 19%; 60‐71% of these patients were on‐target. No significant differences were found after stratification. Logistic regression analyses showed that, compared to SCD patients with CVD, dementia patients with CVD were more likely to use LLD; OR(95%CI) 3.2(1.0;9.8). Further, MCI patients without CVD were more likely to use LLD, compared to SCD patients without CVD; OR(95%CI) 8.6(2.1;35.1). These associations were independent of age, sex and multiple confounders.ConclusionContrary to our expectations, patients with cognitive impairment(with/without CVD) used more LLD than patients with SCD. This relation was not explained by old age, polypharmacy, or physical frailty. Our study provides insight in the current prescribing patterns of LLD in older patients visiting a memory clinic. Future research should focus on the efficacy of LLD use in older patients with cognitive impairment, in order to make a more applicable guideline in whether and when to continue or withdraw LLD in cognitive impaired patients.