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.
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.


OBJECTIVE
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.


BACKGROUND
GN11NE062, NCT02881099.
Department of Neurology, Institute of Neurological Sciences, Glasgow, UK.
Diane M A
DM
Swallow
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Michael A
MA
Lawton
Department of Neurology, Institute of Neurological Sciences, Glasgow, UK.
Katherine A
KA
Grosset
Department of Neurology, Institute of Neurological Sciences, Glasgow, UK.
Naveed
N
Malek
Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Johannes
J
Klein
Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Fahd
F
Baig
Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Claudio
C
Ruffmann
Department of Neurology, Queen's Medical Centre, Nottingham, UK.
Nin P
NP
Bajaj
Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, UK.
Roger A
RA
Barker
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Yoav
Y
Ben-Shlomo
Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK.
David J
DJ
Burn
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK.
Thomas
T
Foltynie
Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK.
Huw R
HR
Morris
Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
Nigel
N
Williams
Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.
Nicholas W
NW
Wood
Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Michele T M
MT
Hu
Department of Neurology, Institute of Neurological Sciences, Glasgow, UK.
Donald G
DG
Grosset
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D010641:Phenotype; D018570:Risk Assessment
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
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