J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 12, Number 4, April 2020, pages 255-265

Cognitive Function Assessment in Patients on Moderate- or High-Intensity Statin Therapy

**Table 1.** Baseline Characteristics
Variable	All patients (n = 213)	(A) Patients on MIST with normal cognitive function (n = 133)	(B) Patients on MIST with cognitive impairment (n = 8)	P (A vs. B)	(C) Patients on HIST with normal cognitive function (n = 42)	(D) Patients on HIST with cognitive impairment (n = 30)	P (C vs. D)	P (B vs. D)
MIST: moderate-intensity statin therapy; HIST: high-intensity statin therapy; SD: standard deviation; LDL: low-density lipoprotein; HDL: high-density lipoprotein; TG: triglyceride; BP: blood pressure.
Age, years, mean (SD)	55.4 (12.9)	53.9 (12.6)	47.3 (12.2)	0.150	59.7 (11.5)	53.4 (14.4)	0.655	0.053
Gender
Male, n (%)	124 (58.2%)	74 (55.6%)	3 (37.5%)	0.468	29 (69%)	18 (60%)	0.461	0.426
Female, n (%)	89 (41.8%)	59 (55.6%)	5 (62.5%)		13 (31%)	12 (40%)
Race
Caucasian, n (%)	78 (36.6%)	49 (36.8%)	3 (37.5%)	0.889	19 (45.2%)	7 (23.3%)	0.214	0.796
African-American, n (%)	67 (31.5%)	44 (33.1%)	3 (37.5%)		9 (21.4%)	11 (36.7%)
Hispanic, n (%)	30 (14.1%)	10 (7.5%)	1 (12.5%)		11 (26.2%)	8 (26.7%)
Other/Asian, n (%)	38 (17.8%)	30 (22.6%)	1 (12.5%)		3 (7.1%)	4 (13.3%)
Education
Beyond high school (> 12)	104 (48.8%)	58 (43.6%)	7 (87.5%)	0.024	22 (52.4%)	22 (73.3%)	0.072	0.650
High school or less (0 - 12)	109 (51.2%)	75(56.7%)	1 (12.5%)		20 (47.6%)	8 (26.7%)
Duration of statin therapy
Less than 5 years, n (%)	36 (16.9%)	21 (15.8%)	3 (37.5%)	0.272	11 (26.2%)	1 (3.3%)	0.032	0.008
5 - 10 years, n (%)	113 (53.1%)	82 (61.7%)	4 (50%)		15 (35.7%)	12 (40%)
More than 10 years, n (%)	64 (30%)	30 (22.6%)	1 (12.5%)		16 (38.1%)	17 (56.7%)
Vitals
Systolic BP (mm Hg), mean (SD)	128 (13.9)	128.1 (13.4)	125.9 (14.4)	0.658	128.1 (14.3)	132.1 (13.8)	0.238	0.269
Diastolic BP (mm Hg), mean (SD)	77.9 (9.5)	78.2 (9.5)	74.9 (10)	0.325	77.3 (10.6)	78.2 (9.2)	0.715	0.383
Lipids
Total cholesterol (mg/dL), mean (SD)	170.7 (38.6)	166.6 (36.8)	195.38(29.8)	0.032	169.3 (41.5)	184.3 (41.3)	0.130	0.485
LDL (mg/dL), mean (SD)	88.2 (31.9)	84.1 (29.5)	114.5 (29.8)	0.005	90.9 (33.5)	96.2 (23.4)	0.528	0.203
HDL (mg/dL), mean (SD)	49.4 (12.3)	49.3 (11.9)	53.5 (11.3)	0.335	47 (13.5)	51.8 (14.4)	0.124	0.728
TG (mg/dL), mean (SD)	169.9 (91)	169.5 (90.7)	136.63 (49.1)	0.313	162.5 (75.9)	190.9 (114.4)	0.242	0.056

Table 1. Baseline Characteristics

Variable

All patients (n = 213)

(A) Patients on MIST with normal cognitive function (n = 133)

(B) Patients on MIST with cognitive impairment (n = 8)

P (A vs. B)

(D) Patients on HIST with cognitive impairment (n = 30)

P (C vs. D)

P (B vs. D)

MIST: moderate-intensity statin therapy; HIST: high-intensity statin therapy; SD: standard deviation; LDL: low-density lipoprotein; HDL: high-density lipoprotein; TG: triglyceride; BP: blood pressure.

Age, years, mean (SD)

55.4 (12.9)

53.9 (12.6)

47.3 (12.2)

0.150

59.7 (11.5)

53.4 (14.4)

0.655

0.053

Gender

Male, n (%)

124 (58.2%)

74 (55.6%)

3 (37.5%)

0.468

29 (69%)

18 (60%)

0.461

0.426

Female, n (%)

89 (41.8%)

59 (55.6%)

5 (62.5%)

13 (31%)

12 (40%)

Race

Caucasian, n (%)

78 (36.6%)

49 (36.8%)

3 (37.5%)

0.889

19 (45.2%)

7 (23.3%)

0.214

0.796

African-American, n (%)

67 (31.5%)

44 (33.1%)

3 (37.5%)

9 (21.4%)

11 (36.7%)

Hispanic, n (%)

30 (14.1%)

10 (7.5%)

1 (12.5%)

11 (26.2%)

8 (26.7%)

Other/Asian, n (%)

38 (17.8%)

30 (22.6%)

1 (12.5%)

3 (7.1%)

4 (13.3%)

Education

Beyond high school (> 12)

104 (48.8%)

58 (43.6%)

7 (87.5%)

0.024

22 (52.4%)

22 (73.3%)

0.072

0.650

High school or less (0 - 12)

109 (51.2%)

75(56.7%)

1 (12.5%)

20 (47.6%)

8 (26.7%)

Duration of statin therapy

Less than 5 years, n (%)

36 (16.9%)

21 (15.8%)

3 (37.5%)

0.272

11 (26.2%)

1 (3.3%)

0.032

0.008

5 - 10 years, n (%)

113 (53.1%)

82 (61.7%)

4 (50%)

15 (35.7%)

12 (40%)

More than 10 years, n (%)

64 (30%)

30 (22.6%)

1 (12.5%)

16 (38.1%)

17 (56.7%)

Vitals

Systolic BP (mm Hg), mean (SD)

128 (13.9)

128.1 (13.4)

125.9 (14.4)

0.658

128.1 (14.3)

132.1 (13.8)

0.238

0.269

Diastolic BP (mm Hg), mean (SD)

77.9 (9.5)

78.2 (9.5)

74.9 (10)

0.325

77.3 (10.6)

78.2 (9.2)

0.715

0.383

Lipids

Total cholesterol (mg/dL), mean (SD)

170.7 (38.6)

166.6 (36.8)

195.38(29.8)

0.032

169.3 (41.5)

184.3 (41.3)

0.130

0.485

LDL (mg/dL), mean (SD)

88.2 (31.9)

84.1 (29.5)

114.5 (29.8)

0.005

90.9 (33.5)

96.2 (23.4)

0.528

0.203

HDL (mg/dL), mean (SD)

49.4 (12.3)

49.3 (11.9)

53.5 (11.3)

0.335

47 (13.5)

51.8 (14.4)

0.124

0.728

TG (mg/dL), mean (SD)

169.9 (91)

169.5 (90.7)

136.63 (49.1)

0.313

162.5 (75.9)

190.9 (114.4)

0.242

0.056

**Table 2.** Comorbid Medical Conditions
Medical comorbidity	All patients (n = 213)	(A) Patients on MIST with normal cognitive function (n = 133)	(B) Patients on MIST with cognitive impairment (n = 8)	P (A vs. B)	(C) Patients on HIST with normal cognitive function (n = 42)	(D) Patients on HIST with cognitive impairment (n = 30)	P (C vs. D)	P (B vs. D)
MIST: moderate-intensity statin therapy; HIST: high-intensity statin therapy; CAD: coronary artery disease; CVA: cerebrovascular accident; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CKD: chronic kidney disease; OSA: obstructive sleep apnea.
Hypertension, n (%)	168 (79.2%)	106 (80.3%)	2 (25%)	0.002	34 (58.2%)	26 (86.7%)	0.750	0.002
Diabetes mellitus, n (%)	167 (78.4%)	110 (82.7%)	6 (75%)	0.632	25 (59.5%)	26 (86.7%)	0.012	0.587
Hypothyroidism, n (%)	29 (13.6%)	19 (14.3%)	0 (0%)	0.598	6 (14.3%)	4(13.3%)	1.000	0.560
Depression, n (%)	42 (19.8%)	25 (18.8%)	3 (37.5%)	0.195	9 (21.4%)	5(16.7%)	0.765	0.327
CAD, n (%)	31 (14.6%)	18 (13.4%)	0 (0%)	0.596	7 (16.7%)	6 (20%)	0.717	0.309
CVA, n (%)	18 (8.5%)	4 (3%)	0 (0%)	1.000	8 (19%)	6 (20%)	0.920	0.309
CHF, n (%)	8 (3.8%)	7 (5.3%)	0 (0%)	1.000	0 (0%)	1 (3.3%)	0.417	1.000
COPD, n (%)	13 (6.1%)	9 (6.8%)	0 (0%)	1.000	2 (4.8%)	2 (6.7%)	1.000	1.000
CKD, n (%)	17 (8%)	18 (6%)	0 (0%)	1.000	4 (9.5%)	5 (16.7%)	0.476	0.563
Anemia, n (%)	23 (10.8%)	12 (9%)	0 (0%)	1.000	8 (19%)	3 (10%)	0.341	1.000
Arthritis, n (%)	42 (19.9%)	23 (17.6%)	0 (0%)	0.352	9 (21.4%)	10 (33%)	0.258	0.082
Malignancy, n (%)	9 (4.2%)	7 (5.3%)	0 (0%)	1.000	1 (2.4%)	1 (3.3%)	1.000	1.000
OSA, n (%)	29 (13.6%)	18 (6%)	1 (12.5%)	1.000	5 (11.9%)	5(16.7%)	0.732	1.000

Table 2. Comorbid Medical Conditions

Medical comorbidity

All patients (n = 213)

(A) Patients on MIST with normal cognitive function (n = 133)

(B) Patients on MIST with cognitive impairment (n = 8)

P (A vs. B)

(D) Patients on HIST with cognitive impairment (n = 30)

P (C vs. D)

P (B vs. D)

MIST: moderate-intensity statin therapy; HIST: high-intensity statin therapy; CAD: coronary artery disease; CVA: cerebrovascular accident; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; CKD: chronic kidney disease; OSA: obstructive sleep apnea.

Hypertension, n (%)

168 (79.2%)

106 (80.3%)

2 (25%)

0.002

34 (58.2%)

26 (86.7%)

0.750

0.002

Diabetes mellitus, n (%)

167 (78.4%)

110 (82.7%)

6 (75%)

0.632

25 (59.5%)

26 (86.7%)

0.012

0.587

Hypothyroidism, n (%)

29 (13.6%)

19 (14.3%)

0 (0%)

0.598

6 (14.3%)

4(13.3%)

1.000

0.560

Depression, n (%)

42 (19.8%)

25 (18.8%)

3 (37.5%)

0.195

9 (21.4%)

5(16.7%)

0.765

0.327

CAD, n (%)

31 (14.6%)

18 (13.4%)

0 (0%)

0.596

7 (16.7%)

6 (20%)

0.717

0.309

CVA, n (%)

18 (8.5%)

4 (3%)

0 (0%)

1.000

8 (19%)

6 (20%)

0.920

0.309

CHF, n (%)

8 (3.8%)

7 (5.3%)

0 (0%)

1.000

0 (0%)

1 (3.3%)

0.417

1.000

COPD, n (%)

13 (6.1%)

9 (6.8%)

0 (0%)

1.000

2 (4.8%)

2 (6.7%)

1.000

CKD, n (%)

17 (8%)

18 (6%)

0 (0%)

1.000

4 (9.5%)

5 (16.7%)

0.476

0.563

Anemia, n (%)

23 (10.8%)

12 (9%)

0 (0%)

1.000

8 (19%)

3 (10%)

0.341

1.000

Arthritis, n (%)

42 (19.9%)

23 (17.6%)

0 (0%)

0.352

9 (21.4%)

10 (33%)

0.258

0.082

Malignancy, n (%)

9 (4.2%)

7 (5.3%)

0 (0%)

1.000

1 (2.4%)

1 (3.3%)

1.000

OSA, n (%)

29 (13.6%)

18 (6%)

1 (12.5%)

1.000

5 (11.9%)

5(16.7%)

0.732

1.000

**Table 3.** Type and Intensity of Statin Therapy
Daily statin	All patients (n = 213)	(A) Patients on MIST with normal cognitive function (n = 133)	(B) Patients on MIST with cognitive impairment (n = 8)	P (A vs. B)	(C) Patients on HIST with normal cognitive function (n = 42)	(D) Patients on HIST with cognitive impairment (n = 30)	P (C vs. D)
MIST: moderate-intensity statin therapy; HIST: high-intensity statin therapy; BID: twice a day.
Atorvastatin 40 - 80 mg, n (%)	50 (23.5%)				30 (71.3%)	20 (66.7%)	0.796
Rosuvastatin 20 - 40 mg, n (%)	22 (10.3%)				12 (28.7%)	10 (33.3%)	0.665
Atorvastatin 10 - 20 mg, n (%)	40 (18.8%)	36 (27.1%)	4 (50%)	0.217
Rosuvastatin 10 mg, n (%)	23 (10.8%)	21 (15.8%)	2 (25%)	0.617
Simvastatin 20 - 40 mg, n (%)	40 (18.8%)	39 (29.3%)	1 (12.5%)	0.440
Pravastatin 40 - 80 mg, n (%)	13 (6.1%)	12 (9%)	1 (12.5%)	0.548
Lovastatin 40 mg, n (%)	8 (3.8%)	8 (6%)	0 (0%)	1.000
Fluvastatin XL 80 mg, n (%)	6 (2.8%)	6 (4.5%)	0 (0%)	1.000
Fluvastatin 40 mg BID, n (%)	4 (1.9%)	4 (3%)	0 (0%)	1.000
Pitavastatin 2 - 4 mg, n (%)	7 (3.3%)	7 (5.3%)	0 (0%)	1.000

Table 3. Type and Intensity of Statin Therapy

Daily statin

All patients (n = 213)

(A) Patients on MIST with normal cognitive function (n = 133)

(B) Patients on MIST with cognitive impairment (n = 8)

P (A vs. B)

(D) Patients on HIST with cognitive impairment (n = 30)

P (C vs. D)

MIST: moderate-intensity statin therapy; HIST: high-intensity statin therapy; BID: twice a day.

Atorvastatin 40 - 80 mg, n (%)

50 (23.5%)

30 (71.3%)

20 (66.7%)

0.796

Rosuvastatin 20 - 40 mg, n (%)

22 (10.3%)

12 (28.7%)

10 (33.3%)

0.665

Atorvastatin 10 - 20 mg, n (%)

40 (18.8%)

36 (27.1%)

4 (50%)

0.217

Rosuvastatin 10 mg, n (%)

23 (10.8%)

21 (15.8%)

2 (25%)

0.617

Simvastatin 20 - 40 mg, n (%)

40 (18.8%)

39 (29.3%)

1 (12.5%)

0.440

Pravastatin 40 - 80 mg, n (%)

13 (6.1%)

12 (9%)

1 (12.5%)

0.548

Lovastatin 40 mg, n (%)

8 (3.8%)

8 (6%)

0 (0%)

1.000

Fluvastatin XL 80 mg, n (%)

6 (2.8%)

6 (4.5%)

0 (0%)

1.000

Fluvastatin 40 mg BID, n (%)

4 (1.9%)

4 (3%)

0 (0%)

1.000

Pitavastatin 2 - 4 mg, n (%)

7 (3.3%)

7 (5.3%)

0 (0%)

1.000