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  • 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

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Movement disorders
Research paper
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
  1. Diane M A Swallow1,
  2. Michael A Lawton2,
  3. Katherine A Grosset1,
  4. Naveed Malek1,
  5. Johannes Klein3,
  6. Fahd Baig3,
  7. Claudio Ruffmann3,
  8. Nin P Bajaj4,
  9. Roger A Barker5,
  10. Yoav Ben-Shlomo2,
  11. David J Burn6,
  12. Thomas Foltynie7,
  13. Huw R Morris8,
  14. Nigel Williams9,
  15. Nicholas W Wood10,
  16. Michele T M Hu3,
  17. Donald G Grosset1,
  18. on behalf of PRoBaND Clinical Consortium11
  1. 1Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
  2. 2School of Social and Community Medicine, University of Bristol, Bristol, UK
  3. 3Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  4. 4Department of Neurology, Queen's Medical Centre, Nottingham, UK
  5. 5Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, UK
  6. 6Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
  7. 7Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
  8. 8Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
  9. 9Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
  10. 10Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
  11. 11UK Clinical Consortium, 72 Clinical Centres across the UK
  1. Correspondence to Dr Diane Swallow, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; diane.swallow{at}nhs.net

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.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/jnnp-2016-313642

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    Footnotes

    • Contributors DMAS contributes to data analysis, manuscript writing and editing; MAL contributes to data analysis, manuscript editing; KAG and DGG contribute to the study design, data collection and analysis, manuscript writing and editing; NM contributes to data collection and manuscript editing; FB, CR, JK, NPB, RAB, DJB, TF, HRM and MTMH contribute to the study design, data collection and manuscript editing; YB-S contributes to the study design, manuscript editing; NW and NWW contribute to the study design.

    • Funding National Institute for Health Research (NIHR) Dementias and Neurodegenerative Diseases Research Network (DeNDRoN); NIHR Biomedical Research Centre in Cambridge; NIHR Oxford Biomedical Research Centre; NIHR Newcastle Biomedical Research Unit; Parkinson's UK (grant number 10.13039/501100000304); Michael's Movers for Parkinson's (Registered Charity No: SC042915). Parkinson's UK grant numbers for the Tracking Parkinson's and Oxford discovery cohort are J-1101 and J-1403 respectively.

    • Competing interests 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.

    • Ethics approval Multicentre ethics committee and local research and development approvals for each site.

    • Provenance and peer review Not commissioned; externally peer reviewed.