This project will examine the role of cholesterol-lowering medications, i.e. statin therapies on the brain. The goal of statin therapy is to prevent the occurrence of heart attacks and stroke by lowering one’s cholesterol, thereby regulating plaque build-up and vascular events. However, cholesterol is also a vital building block for myelin, which provides support for the brain and its connections. Since cholesterol is a vital component of myelin, and myelin is critical for cognitive function, changes in cholesterol levels by statins may also impact cognition.
In 2012 the FDA issued a warning that changes in memory and thinking were a known side effect of statins. As most research completed to date has been aimed at identifying risk reduction for vascular events, previous studies have not examined the direct impact of statins on brain function. The mechanism for this relationship therefore remains unclear. Furthermore, it remains controversial whether women derive the same risk-reducing benefits as men and they often experience a greater number of side effects. Despite this, women have historically not been as involved in clinical trials. We seek to address these gaps in the literature.
This study uses quantitative high field (3 Tesla) Magnetic Resonance Imaging (MRI) and cognitive testing to evaluate the brain’s microstructure and function. We plan to perform a longitudinal study, evaluating patients’ brains before initiating treatment and after 12 weeks of statin use in 20 women ages 45-85. The same procedures will be performed on 10 age-matched controls who are not prescribed or taking statins.
At the completion of this project, we aim to successfully quantify the effects of 12 weeks of statin therapy on the microstructure and function of the brain. In doing so, we hope to elucidate the possible effects of statin use on brain function, and offer a potential mechanism for observations of even subtle cognitive dysfunction in otherwise neurologically healthy adults.
In response to the increasing number of heart-related deaths and rise in heart disease in the U.S. statin drugs were first introduced in 1987 to reduce cholesterol levels in the body. According to the National Center for Health Statistics, statin use increased from 20 to 28% over the period of 2003-2012, reflecting a tremendous expansion in how these drugs are now prescribed. Importantly, in 2012 the FDA issued new warning label changes that identify memory loss and confusion as significant side effects, though this has seemingly not impacted prescription rates. By quantifying the microstructural and cognitive changes that accompany statin use, this study aims to generate objective evidence on the effects of stain use on the brain. Critically, this may catalyze future investigations on the specific indications and conditions required to justify statin use and support the identification of individuals particularly vulnerable to its effects.
Neuropsychology Postdoctoral Fellow
Medical University of South Carolina