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

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.

Conflict of interest statement

NPB has received payment for advisory board attendance from UCB, Teva Lundbeck, Britannia, GSK, Boehringer and honoraria from UCB Pharma, GE Healthcare, Lily Pharma, Medtronic. He has received research grant support from GE Healthcare, Wellcome Trust, MRC and Parkinson's UK and royalties from Wiley. RAB has received grants from Parkinson's UK, NIHR, Cure Parkinson's Trust, Evelyn Trust, Rosetrees Trust, MRC and EU along with payment for advisory board attendance from Oxford Biomedica and LCT, and honoraria from Wiley and Springer. DJB has received grants from NIHR, Wellcome Trust, GlaxoSmithKline, Parkinson's UK and Michael J Fox Foundation. He has acted as consultant for GSK. TF has received payment for advisory board meetings for Abbvie and Oxford Biomedica, and honoraria for presentations at meetings sponsored by Medtronic, St Jude Medical, Britannia and Teva pharmaceuticals. HRM has received grants from Medical Research Council UK, Wellcome Trust, Parkinson's UK, Ipsen Fund, Motor Neurone Disease Association, Welsh Assembly Government, PSP Association, CBD Solutions and Drake Foundation, and payment for advisory board attendance and lectures from Acorda, Teva, AbbVie, Medtronic, Boehringer Ingelheim, UCB and GSK. MTMH has received grants from Parkinson's UK, Michael J Fox Foundation, GE Healthcare, NIHR and Cure Parkinson's Trust. DGG has received grants from Parkinson's UK, Michael's Movers, the Paul Hamlyn Foundation, payment for advisory board attendance from AbbVie and honoraria from UCB Pharma, GE Healthcare and Acorda.

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Figures

Figure 1

Disposition of cases recruited to the study, and reasons for exclusion. The main analysis was performed in 2909 cases; clinical correlates were examined in 2611 cases, to reduce any effect of possible diagnostic inaccuracy. PD, Parkinson's disease, PSP, progressive supra nuclear palsy, MSA, multiple system atrophy.