According to one recent statements a American Heart Association (American Heart Association, AHA), the scientific evidence accumulated to date indicates that significant reductions in LDL cholesterol levels do not increase the risk of cognitive impairment, dementia, or hemorrhagic stroke. Treatment with statins and other new lipid-lowering therapies is safe, and physicians are encouraged to prescribe optimal doses to achieve cholesterol targets for each patient.
Current international guidelines recommend a more aggressive approach to lowering LDL cholesterol levels, which involves using a combination of statins, PCSK9 inhibitors, ezetimibe and other new therapies to reduce the risk of atherosclerotic cardiovascular disease. However, there is significant reluctance among doctors to adopt these aggressive approaches, mainly due to concerns about possible adverse effects on the brain.
In this context, the AHA conducted an extensive review of the literature, focusing in particular on randomized clinical trials. The new position paper aims to inform physicians about the safety and benefits of intensive treatment for dyslipidemia.
EBBINGHAUS is a reference study that showed that lowering cholesterol to very low values does not cause cognitive impairment or increase the risk of dementia. The study included patients who achieved LDL cholesterol levels below 25 mg/dL with the PCSK9 inhibitor, evolocumab.
Several randomized clinical trials, incl SPARCLThe study Treat Stroke to Target, ODYSSEY Outcomes and FOURIER, shows that there is no evidence for a significant risk of hemorrhagic stroke in patients receiving statins or ezetimibe. Individuals with low lifetime LDL-c values have not been shown to have an increased vulnerability to develop cerebral hemorrhage, and the addition of lipid-lowering therapies does not increase this risk. Thus, physicians should follow guideline LDL-c-lowering recommendations without reservations about the risk of hemorrhagic stroke.
Population-wide lipid control is well below guideline-recommended targets due to underutilization of effective therapies, which are linked to concerns about side effects, including statin-associated muscle symptoms and the risk of neurological complications.
There have been theories over time that support the risk of damage from cholesterol treatment, as the brain contains about 25% of the body’s total cholesterol. However, AHA experts explained that lipid and cholesterol metabolism in the brain is separated from that in the systemic circulation by the blood-brain barrier, meaning that pharmacological agents that affect hepatic lipid metabolism are unlikely to impact the brain.
“Given our findings, physicians should feel much more confident in engaging in aggressive lipid-lowering according to guidelines without concern about any adverse effects on the central nervous system.” – concludes Peter Toth, MD, CGH Rock Falls Medical Center, one of the authors of the paper.
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2023-10-04 07:25:00
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