血圧およびコレステロール低下の認知機能への影響(LBCT.01)

HOPE 3：長期の降圧およびコレステロール低下療法は認知機能低下を予防しない
HOPE 3: Long term blood pressure and cholesterol lowering did not prevent cognitive decline
2016年American Heart Association 学術集会で発表されたHeart Outcomes Prevention Evaluation-3（HOPE 3）において研究者らは、心血管疾患中等度リスク者において、長期間のコレステロール低下療法または降圧療法が、認知機能低下を遅延させるかどうかを評価した。参加者は平均74歳、59%が女性であった。それぞれの群の参加者は認知機能低下を来したが、どちらの治療も参加者の認知機能に対し悪影響は何も及ぼさなかった。今回の中等度リスク者において、5年半の降圧療法およびコレステロール低下療法は、認知機能低下を予防しなかった。早期の、より長期にわたる治療が有益である可能性については、不明である。
Full Text

No strategy has been found to reliably prevent cognitive impairment or dementia.  In the Heart Outcomes Prevention Evaluation-3 (HOPE 3) presented at the American Heart Association Scientific Sessions 2016, researchers evaluated whether long-term cholesterol lowering or blood pressure-lowering delayed cognitive decline in individuals at moderate risk for cardiovascular disease. 

12,705 participants were randomized to receive either blood pressure medication (candesartan /hydrochlorothiazide) or placebo and a cholesterol-lowering statin (rosuvastatin) or placebo. 1,626 study participants also completed cognitive and functional outcome questionnaires at baseline and study end almost six years later.

Participants came from 221 centers in 21 countries and were on average 74 years old and 59 percent were women.

Participants in each group did demonstrate cognitive decline, but there was no difference in the decline between those in the active or control groups for the blood pressure lowering arm or the cholesterol lowering arm or the combination. Neither treatment demonstrated any adverse effect on cognition.

Five and half years of blood pressure lowering and cholesterol lowering in an intermediate risk population did not prevent cognitive decline. It is not clear if early initiation and longer term treatment may have benefit.