Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
Division of Vascular Neurology, Department of Neurology, University of Utah, Salt Lake City.
Neurologist. 2023 Mar 1;28(2):94-98. doi: 10.1097/NRL.0000000000000448.
Progression of white matter hyperintensities (WMHs), a radiographic marker of cerebral small vessel disease, occurs with uncontrolled conventional cerebrovascular risk factors. Less certain, however, is the influence of dyslipidemia and the impact of 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) on WMH progression. The goal of this study was to evaluate the influence of statins on the progression of WMH over a 4-year interval.
We performed a post hoc analysis of the SPRINT-MIND database on those with serial volumetric WMH data. WMH progression was calculated as the difference in WMH volume between the 2 scans and then segmented into tertiles due to rightward skew. We defined statin usage as no therapy (0% of visits), partial therapy (1% to 99% of visits) or full therapy (100% of visits) as logged during study visits. Analysis of variance and χ 2 tests were used for continuous and categorical variables with adjustments made for variables known to influence WMH development.
A total of 425 individuals were included in this study: 53% without statins use, 27% partial use, and 20% full use. Demographic characteristics and baseline WMH volumes were similar among the cohort. Those with full statin use were significantly more likely to be in the top tertile of WMH progression (adjusted odds ratio: 2.30, 95% confidence interval: 1.11-4.77, P =0.025), despite improvement in dyslipidemia.
SPRINT-MIND participants prescribed a statin were nearly 2.5 times more likely to be within the top tertile of WMH progression over 4 years, despite adjustment for synergistic risk factors and improvement in low-density lipoprotein.
脑小血管疾病的影像学标志物——脑白质高信号（WMH）的进展与未控制的常规脑血管危险因素有关。然而，血脂异常的影响以及 3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）对 WMH 进展的影响尚不确定。本研究的目的是评估他汀类药物在 4 年时间内对 WMH 进展的影响。
我们对有连续容积 WMH 数据的 SPRINT-MIND 数据库进行了事后分析。WMH 进展是通过两次扫描之间的 WMH 体积差异计算得出的，然后由于右偏分布将其分为三分位。我们将他汀类药物的使用定义为无治疗（研究访视中 0%的时间）、部分治疗（1%至 99%的时间）或全治疗（100%的时间）。使用方差分析和 χ 2 检验对连续和分类变量进行分析，并对已知影响 WMH 发展的变量进行调整。
本研究共纳入 425 人：53%的人未使用他汀类药物，27%的人部分使用，20%的人完全使用。队列中的人口统计学特征和基线 WMH 体积相似。尽管血脂异常得到改善，但完全使用他汀类药物的人更有可能处于 WMH 进展的最高三分位（调整后的优势比：2.30，95%置信区间：1.11-4.77，P=0.025）。
尽管调整了协同危险因素和低密度脂蛋白的改善，SPRINT-MIND 参与者处方他汀类药物的人在 4 年内处于 WMH 进展最高三分位的可能性几乎增加了 2.5 倍。
