Effect of Low-Dose Statins and Apolipoprotein E Genotype on Cerebral Small Vessel Disease in Older Hypertensive Patients: A Subgroup Analysis of a Randomized Clinical Trial

Objectives: To investigate the effect of low-dose statins and apolipoprotein E (APOE) genotypes on cerebral small vessel disease (CSVD) to prevent CSVD in older hypertensive patients. Design: A subgroup analysis of a randomized clinical trial. Setting: Shandong area, China. Participants: Hypertensive patients aged >= 60 years were recruited from April 2008 to November 2010. Measurements: Patients were randomly assigned to rosuvastatin (10 mg/day) or placebo groups. APOE genotypes were categorized as 84 carriers and non-84 carriers. White matter hyperintensities (WMH), Fazekas scale, lacunes, and microbleeds were assessed. Results: After an average of intervention period of 61.8 months, WMH volume increased 1.45 +/- 0.52 mL. There were 107 new-incident Fazekas scale >= 2, 65 new-incident lacunes, and 63 new-incident microbleeds. The increase in WMH volume was significantly lower in the rosuvastatin group than in the placebo group and was higher in APOE epsilon 4 carriers than in non-epsilon 4 carriers (all adjusted P < .001). The risk of new-incident Fazekas scale >= 2 was higher in the placebo group than in the rosuvastatin group (hazard ratio 2.150, 95% confidence interval 1.443-3.203; P < .001). APOE epsilon 4 carriers were associated with an increased risk of new-incident Fazekas scale >= 2 compared with non-epsilon 4 carriers (hazard ratio 1.973, 95% confidence interval 1.334-2.920; P = .001). There were no statistically significant differences in the risk of new-incident cerebral microbleeds between the rosuvastatin and placebo groups or between APOE epsilon 4 carriers and non-epsilon 4 carriers. There were no significant interactions between rosuvastatin use and APOE 84 status regarding increased WMH volume (F = 1.020, P = .313) or for new-incident Fazekas scale >= 2 (P = .377), lacunes (P = .232), and microbleeds (P = .362). Conclusions/Implications: Low-dose rosuvastatin is an effective and safe therapy for CSVD. The presence of APOE 84 allele may not be able to predict rosuvastatin treatment outcomes for preventing and/or treating CSVD in older hypertensive patients. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.