Magazine article Clinical Psychiatry News

Lipid Lowering Reverses Cognitive Decline in Some Atrial Fibrillation

Magazine article Clinical Psychiatry News

Lipid Lowering Reverses Cognitive Decline in Some Atrial Fibrillation

Article excerpt

VIENNA -- Potent cholesterol-lowering therapy appears to reverse neurocognitive decline in normolipidemic elderly patients with atrial fibrillation, Dr. Elke Wezenberg said at the annual congress of the European Society of Cardiology.

If this new finding from the small pilot SPACE (Silent Brain Infarction and Cognitive Decline Prevention in Atrial Fibrillation by Cholesterol Lowering in the Elderly) trial is confirmed in a planned larger, more definitive study, then the use of lipid-lowering medications would be warranted in all patients with atrial fibrillation (AF), regardless of their cholesterol level, added Dr. Wezenberg, a psychiatrist at Radboud University, Nijmegen, the Netherlands.

She attributed the positive cognitive effects of the SPACE regimen of 40 mg of atorvastatin/10 mg of ezetimibe daily to the drugs' anti-inflammatory action. Participants had relatively high baseline C-re-active protein (CRP) levels indicative of extensive systemic inflammation.

Their CRP levels decreased significantly during 1 year of lipid lowering, and the decline correlated inversely with the observed improvement in cognitive function.

SPACE was a double-blind, placebo-controlled prospective study involving 31 patients, mean age 74, with an average 14-year history of AF. All were on warfarin and adequately anticoagulated, with an international normalized ratio of 2.0-3.0. At base line and again after 1 year, participants were evaluated for depression using the Montgomery-Asberg Depression Rating Scale (MADRS), by MRI for white matter lesions, as well as by an extensive neuropsychologic test battery for memory, language, executive function, and speed of information processing. …

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