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Reducing hypertriglyceridemia in elderly patients with cerebrovascular disease stabilizes or improves cognition and
R L Rogers1, J S Meyer, K McClintic
1Cerebral Blood Flow Laboratories, Veterans Administration Medical Center, Houston.
Insights
Lowering high triglyceride levels with gemfibrozil improved cerebral blood flow and cognitive function in elderly patients. This suggests triglyceride management may benefit brain health in individuals with cerebrovascular disease risk factors.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Elderly individuals with hypertriglyceridemia often present with cerebrovascular disease risk factors.
- Reduced cerebral perfusion and cognitive decline are significant concerns in this population.
- Symptomatic occlusive cerebrovascular disease necessitates effective management strategies.
Purpose of the Study:
- To investigate the effects of lowering serum triglyceride levels on cerebral perfusion and cognitive function in elderly patients.
- To evaluate the efficacy of gemfibrozil in managing hypertriglyceridemia and its impact on neurological outcomes.
Main Methods:
- A randomized controlled trial involving 44 elderly hypertriglyceridemic patients.
- Patients were assigned to receive gemfibrozil (600 mg daily) or placebo, alongside a lipid-lowering diet.
- Cerebral blood flow was measured using the xenon 133 inhalation method, and cognitive function was assessed via the Cognitive Capacity Screening Examination.
Main Results:
- Gemfibrozil treatment significantly reduced serum triglyceride levels (p < .0005) without affecting total cholesterol.
- Patients receiving gemfibrozil demonstrated significantly higher cerebral blood flow and cognitive scores compared to controls.
- Improvements in cerebral blood flow and cognition showed a linear correlation with the duration of gemfibrozil treatment.
Conclusions:
- Lowering serum triglyceride levels through gemfibrozil administration benefits cerebral perfusion and cognitive performance in elderly hypertriglyceridemic patients.
- Triglyceride management may be a viable therapeutic strategy for improving brain health in individuals at risk for cerebrovascular events.
- The positive effects on cerebral blood flow and cognition suggest a potential role for lipid-lowering agents in preventing or mitigating cognitive decline associated with cerebrovascular disease.
Abstract:
Effects of lowering serum triglyceride levels were investigated among 44 elderly hypertriglyceridemic patients with risk factors for stroke, reduced cerebral perfusion, and a history compatible with symptomatic occlusive cerebrovascular disease. Patients were randomly assigned to either treatment with gemfibrozil, a lipid-lowering agent, or control conditions. Subjects in both groups were instructed to follow a diet recommended for lowering serum lipid levels, while the treatment group was additionally administered 600 mg daily of gemfibrozil. Subjects assigned to the treatment group (n = 22) showed significant reductions in serum triglyceride levels (p less than .0005). Control subjects (n = 22) did not show any significant changes in serum triglyceride levels. There were also no significant changes in total cholesterol levels in either group. Analyses of values for mean bihemispheric gray matter cerebral blood flow measured by the xenon 133 inhalation method and cognitive scores tested by the Cognitive Capacity Screening Examination indicated that gemfibrozil-treated patients maintained significantly higher levels of cerebral perfusion and cognitive performance than untreated controls did. Regression analyses for different treatment intervals indicated that both cerebral blood flow and cognition showed linear improvements that correlated directly with the duration of treatment. Lowering triglyceride levels in hyperlipidemic subjects appears to benefit cerebral perfusion and cognitive performance after four to six months.