Studies into the association between LDL-C lowering and cognitive function:time to forget about it?

• 作者: Shirin Ibrahim Laurens F.Reeskamp G.Kees Hovingh
• 来源期刊: 科学通报（英文版）
• 年，卷（期）: 2021,（16）
• 所属期刊栏目: COMMENTARY
• 页码范围: 1614-1615
• 页数: 2页
• 语种: 英文

摘要

Lipid lowering is the cornerstone in the prevention of cardiovas-cular disease(CVD),which is based on a plethora of data bolstering the causal role of low-density lipoprotein cholesterol(LDL-C)in the process of atherosclerosis.However,a concern that has been raised in this regard is whether LDL-C lowering agents,or the subsequent low LDL-C levels,result in cognitive impairment,offsetting the beneficial effect of LDL-C lowering on CVD outcomes.This concern has been fueled by the fact that cholesterol is the main constituent of the brain myelin encircling neurons[1].Moreover,there have been anecdotal reports of statin induced cognitive symptoms[2].However,clear pathophysiological evidence that(pharmacologi-cally induced)low LDL-C levels negatively influence lipid home-ostasis in the brain is lacking.Practically all cholesterol content present in the central nervous system is synthetized de novo in brain cells since the impermeable blood-brain barrier separates lipoprotein metabolism in the brain from the rest of the body[3].In fact,a number of studies have shown that statins resulted in a lower incidence of different types of dementia,for example Alzhei-mer's disease[4,5].Schilling et al.,[5]for example,showed that higher LDL-C and total cholesterol concentrations at baseline were associated with an increased risk of Alzheimer's disease with a hazard ratio per standard deviation(SD)increase of 1.3(95％con-fidential interval(CI)1.04-1.22,P = 0.0045),and 1.12(95％CI 1.03-1.22,P = 0.0072),respectively.