Cholesterol-Lowering Drug Does Not Cause Cognitive Decline
A recent study showed that the cholesterol-lowering drug evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, does not lead to cognitive decline.
Previous studies have suggested that PCSK9 inhibitors, or the low levels of low-density lipoprotein (LDL) cholesterol that result from their use, are associated with cognitive decline.
___________________________________________________________________________________________________________
RELATED CONTENT
Cholesterol, Sodium, and the Mediterranean Diet
Very Low LDL Cholesterol Levels Can Decrease CVD Risk
___________________________________________________________________________________________________________
To study this relationship further, the researchers evaluated 1204 patients over a median of 19 months. In addition to statin therapy, patients received either evolocumab or placebo. Cognitive function was assessed at baseline, week 24, annually, and at final follow-up (median 19 months) via the Cambridge Neuropsychological Test Automated Battery.
The researchers defined the primary outcome as the score on the spatial working memory strategy index of executive function. Scores range from 4 to 28, with lower scores indicating a more efficient use of strategy and planning. The secondary outcomes were the scores for working memory (scores range from 0 to 279, with lower scores indicating fewer errors), episodic memory (scores range from 0 to 70, with lower scores indicating fewer errors), and psychomotor speed (scores range from 100 to 5100 msec, with faster times representing better performance).
Results indicated that the mean change from baseline over time in the raw score for the spatial working memory strategy index of executive function was −0.21 among patients on evolocumab and −0.29 among patients on placebo.
The researchers observed no significant differences between groups in the secondary end points of scores for working memory (change in raw score, −0.52 in the evolocumab group and −0.93 in the placebo group), episodic memory (change in raw score, −1.53 in the evolocumab group and −1.53 in the placebo group), or psychomotor speed (5.2 msec in the evolocumab group and 0.9 msec in the placebo group).
Furthermore, an exploratory analysis demonstrated no associations between LDL cholesterol levels and cognitive changes.
“In a randomized trial involving patients who received either evolocumab or placebo in addition to statin therapy, no significant between-group difference in cognitive function was observed over a median of 19 months,” the researchers concluded.
—Christina Vogt
Reference:
Giugliano RP, Mach F, Zavitz K, et al. Cognitive function in a randomized trial of evolocumab [Published online August 17, 2017]. N Engl J Med. doi:10.1056/NEJMoa1701131.