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

Diane M A Swallow, Michael A Lawton, Katherine A Grosset, Naveed Malek, Johannes Klein, Fahd Baig, Claudio Ruffmann, Nin P Bajaj, Roger A Barker, Yoav Ben-Shlomo, David J Burn, Thomas Foltynie, Huw R Morris, Nigel Williams, Nicholas W Wood, Michele T M Hu, Donald G Grosset

Research output: Contribution to journalArticle

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Abstract

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.

OBJECTIVES: 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.

TRIAL REGISTRATION NUMBER: GN11NE062, NCT02881099.

Original languageEnglish
Pages (from-to)1183-1190
Number of pages8
JournalJournal of Neurology, Neurosurgery & Psychiatry
Volume87
Issue number11
Early online date13 Oct 2016
DOIs
Publication statusPublished - Nov 2016

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Blood Vessels
Parkinson Disease
Phenotype
Cardiovascular Diseases
Vascular Diseases
Tunica Media
Cognition

Keywords

  • Age Factors
  • Aged
  • Cardiovascular Diseases
  • Comorbidity
  • Cross-Sectional Studies
  • Drug Utilization
  • England
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Male
  • Middle Aged
  • Parkinson Disease
  • Phenotype
  • Risk Assessment
  • Journal Article

Cite this

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. / Swallow, Diane M A; Lawton, Michael A; Grosset, Katherine A; Malek, Naveed; Klein, Johannes; Baig, Fahd; Ruffmann, Claudio; Bajaj, Nin P; Barker, Roger A; Ben-Shlomo, Yoav; Burn, David J; Foltynie, Thomas; Morris, Huw R; Williams, Nigel; Wood, Nicholas W; Hu, Michele T M; Grosset, Donald G.

In: Journal of Neurology, Neurosurgery & Psychiatry, Vol. 87, No. 11, 11.2016, p. 1183-1190.

Research output: Contribution to journalArticle

Swallow, DMA, Lawton, MA, Grosset, KA, Malek, N, Klein, J, Baig, F, Ruffmann, C, Bajaj, NP, Barker, RA, Ben-Shlomo, Y, Burn, DJ, Foltynie, T, Morris, HR, Williams, N, Wood, NW, Hu, MTM & Grosset, DG 2016, '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', Journal of Neurology, Neurosurgery & Psychiatry, vol. 87, no. 11, pp. 1183-1190. https://doi.org/10.1136/jnnp-2016-313642
Swallow, Diane M A ; Lawton, Michael A ; Grosset, Katherine A ; Malek, Naveed ; Klein, Johannes ; Baig, Fahd ; Ruffmann, Claudio ; Bajaj, Nin P ; Barker, Roger A ; Ben-Shlomo, Yoav ; Burn, David J ; Foltynie, Thomas ; Morris, Huw R ; Williams, Nigel ; Wood, Nicholas W ; Hu, Michele T M ; Grosset, Donald G. / 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. In: Journal of Neurology, Neurosurgery & Psychiatry. 2016 ; Vol. 87, No. 11. pp. 1183-1190.
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abstract = "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.OBJECTIVES: 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.TRIAL REGISTRATION NUMBER: GN11NE062, NCT02881099.",
keywords = "Age Factors, Aged, Cardiovascular Diseases, Comorbidity, Cross-Sectional Studies, Drug Utilization, England, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Parkinson Disease, Phenotype, Risk Assessment, Journal Article",
author = "Swallow, {Diane M A} and Lawton, {Michael A} and Grosset, {Katherine A} and Naveed Malek and Johannes Klein and Fahd Baig and Claudio Ruffmann and Bajaj, {Nin P} and Barker, {Roger A} and Yoav Ben-Shlomo and Burn, {David J} and Thomas Foltynie and Morris, {Huw R} and Nigel Williams and Wood, {Nicholas W} and Hu, {Michele T M} and Grosset, {Donald G}",
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TY - JOUR

T1 - Statins are underused in recent-onset Parkinson's disease with increased vascular risk

T2 - findings from the UK Tracking Parkinson's and Oxford Parkinson's Disease Centre (OPDC) discovery cohorts

AU - Swallow, Diane M A

AU - Lawton, Michael A

AU - Grosset, Katherine A

AU - Malek, Naveed

AU - Klein, Johannes

AU - Baig, Fahd

AU - Ruffmann, Claudio

AU - Bajaj, Nin P

AU - Barker, Roger A

AU - Ben-Shlomo, Yoav

AU - Burn, David J

AU - Foltynie, Thomas

AU - Morris, Huw R

AU - Williams, Nigel

AU - Wood, Nicholas W

AU - Hu, Michele T M

AU - Grosset, Donald G

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2016/11

Y1 - 2016/11

N2 - 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.OBJECTIVES: 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.TRIAL REGISTRATION NUMBER: GN11NE062, NCT02881099.

AB - 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.OBJECTIVES: 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.TRIAL REGISTRATION NUMBER: GN11NE062, NCT02881099.

KW - Age Factors

KW - Aged

KW - Cardiovascular Diseases

KW - Comorbidity

KW - Cross-Sectional Studies

KW - Drug Utilization

KW - England

KW - Female

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors

KW - Male

KW - Middle Aged

KW - Parkinson Disease

KW - Phenotype

KW - Risk Assessment

KW - Journal Article

U2 - 10.1136/jnnp-2016-313642

DO - 10.1136/jnnp-2016-313642

M3 - Article

VL - 87

SP - 1183

EP - 1190

JO - Journal of Neurology, Neurosurgery & Psychiatry

JF - Journal of Neurology, Neurosurgery & Psychiatry

SN - 0022-3050

IS - 11

ER -