Observational studies of statin use to lower LDL-C have shown a decreased risk of
Alzheimer disease. In contrast, randomized controlled treatment trials of statins to
treat established AD have been uniformly negative. In a small group of study
subjects at high risk of CVD, higher LDL-C and lower levels of HDL-C were associated
with greater brain amyloid levels independently of APOE genotype. This
finding suggests that healthy HDL-C and LDL-C levels can protect against the
deposition of brain amyloid just as they protect against cardiovascular disease.66
The role of hypertension
The American Heart Association recognizes that chronic arterial hypertension is a
well-established risk factor for vascular and Alzheimer dementia. It disrupts the
structure and function of cerebral blood vessels, leads to inadequate blood perfusion
and damage of white matter regions critical for cognitive function, and may promote
Alzheimer disease pathology.
Chronic hypertension can cause a series of small strokes that may not be recognized.
The resulting cumulative brain damage can cause multi-infarct or vascular dementia
that is second only to Alzheimer disease as the most common cause of dementia,
and vascular damage to the brain may lead to or contribute to Alzheimer disease.
Because vascular brain injury develops insidiously over a long time, diagnosing and
treating high blood pressure at a young age could improve late-life cognitive health.
Research based on data from the Framingham Heart Study found that among individuals
in their 40s, those with prehypertension or any degree of increased blood
pressure had damage to the structural integrity of the brain’s white matter and decreases
in the volume of brain gray matter. The study found that the higher the
blood pressure, the greater the amount of brain injury, cognitive decline, and probably
the risk of dementia.
A meta-analysis of 14 randomized clinical trials with an average duration of 4.1
years found that blood pressure lowering with antihypertensive agents was associated
with a lower rate of development of dementia or cognitive impairment at 7.0%
of those treated compared to 7.5% of patients in a control group, a difference that
was statistically significant.
A study with long-term (24 year) follow-up found that individuals with mid-life
hypertension have increased risk for dementia and that mid-life hypertension that is
followed by late-life low blood pressure was associated with even greater risk for
dementia. The SPRINT/MIND trial found that over 5 years, intensive (systolic
blood pressure target less than 120 mm Hg,), rather than standard blood pressure
lowering (SBP less than 140 mm Hg.) in adults age 50 or older did not decrease
the risk of probable dementia, but it did significantly reduce by 19% the risk of
mild cognitive impairment—a frequent precursor of dementia.74 The same study
found intensive blood pressure treatment resulted in a small decrease in dementia
associated white matter brain lesions but a small decrease in total brain volume—a
sign of brain atrophy. Editorial comment on this result was that earlier, midlife
management of blood pressure may be optimal, and later blood pressure lowering
interventions require careful monitoring for the potential cognitive harm associated
with late-life low blood pressure.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.