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

Abstract 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 e4 carriers and non- e4 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 e4 carriers than in non- e4 carriers (all adjusted P P APOE e4 carriers were associated with an increased risk of new-incident Fazekas scale ≥2 compared with non- e4 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 e4 carriers and non- e4 carriers. There were no significant interactions between rosuvastatin use and APOE e4 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 e4 allele may not be able to predict rosuvastatin treatment outcomes for preventing and/or treating CSVD in older hypertensive patients.