title: Prestroke statins, progression of white matter hyperintensities, and cognitive decline in stroke patients with confluent white matter hyperintensities.
abstract: Cerebral white matter hyperintensities (WMH) are a consequence of cerebral small vessel disease. Statins have been shown to reduce recurrent stroke among patients with various stroke subtypes, including lacunar stroke, which also arises from small vessel disease. In this study, we investigated the hypothesis that prestroke statin use would reduce the progression of WMH and/or cognitive decline among stroke patients with confluent WMH. Patients (n = 100) were participants of the VITAmins To Prevent Stroke magnetic resonance imaging substudy. All patients had confluent WMH on magnetic resonance imaging at baseline. Eighty-one patients completed the 2-year follow-up. We assessed general cognition and executive function using the mini-mental state examination and Mattis dementia rating scale-initiation/perseveration subscale, respectively. We compared the change in volume of WMH and cognition between prestroke statin use and prestroke nonstatin use groups. We also evaluated the effects of prestroke statin use on incident lacunes and microbleeds. The prestroke statin use group (n = 51) had less WMH volume progression (1.54 ± 4.52 cm(3) vs 5.01 ± 6.00 cm(3), p = 0.02) compared with the prestroke nonstatin use group (n = 30). Multivariate linear regression modeling identified prestroke statin use as an independent predictor of WMH progression (β = -0.31, p = 0.008). Prestroke statin use was also associated with less decline (Mattis dementia rating scale-initiation/perseveration subscale; β = 0.47, p = 0.001). No association was observed with changes in mini-mental state examination scores. There were no between group differences on incident lacunes or incident microbleeds. Prestroke statin use may reduce WMH progression and decline in executive function in stroke patients with confluent WMH.
authors.affiliation: Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China.
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Xiong
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.forename: Margherita
authors.initials: M
authors.lastname: Cavalieri
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Winnie W C
authors.initials: WW
authors.lastname: Chu
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
mesh_terms: D000368:Aged; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020521:Stroke / Q000150:complications*; D014805:Vitamin B 12 / Q000627:therapeutic use; D025101:Vitamin B 6 / Q000627:therapeutic use; D066127:White Matter / Q000473:pathology*
chemical_list: D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12