• Diane M A Swallow, Michael A Lawton, Katherine A Grosset, Naveed Malek, Johannes Klein, Fahd Baig, Claudio Ruffmann, Nin P Bajaj, Roger A Barker, Yoav Ben-Shlomo, David J Burn, Thomas Foltynie, Huw R Morris, Nigel Williams, Nicholas W Wood, Michele T M Hu, and Donald G Grosset.
• Department of Neurology, Institute of Neurological Sciences, Glasgow, UK.
• J. Neurol. Neurosurg. Psychiatr. 2016 Nov 1; 87 (11): 118311901183-1190.

BackgroundCardiovascular disease (CVD) influences phenotypic variation in Parkinson's disease (PD), and is usually an indication for statin therapy. It is less clear whether cardiovascular risk factors influence PD phenotype, and if statins are prescribed appropriately.ObjectivesTo quantify vascular risk and statin use in recent-onset PD, and examine the relationship between vascular risk, PD severity and phenotype.MethodsCardiovascular risk was quantified using the QRISK2 calculator (high ≥20%, medium ≥10 and <20%, low risk <10%). Motor severity and phenotype were assessed using the Movement Disorder Society Unified PD Rating Scale (UPDRS) and cognition by the Montreal cognitive assessment.ResultsIn 2909 individuals with recent-onset PD, the mean age was 67.5 years (SD 9.3), 63.5% were men and the mean disease duration was 1.3 years (SD 0.9). 33.8% of cases had high vascular risk, 28.7% medium risk, and 22.3% low risk, while 15.2% of cases had established CVD. Increasing vascular risk and CVD were associated with older age (p<0.001), worse motor score (p<0.001), more cognitive impairment (p<0.001) and worse motor phenotype (p=0.021). Statins were prescribed in 37.2% with high vascular risk, 15.1% with medium vascular risk and 6.5% with low vascular risk, which compared with statin usage in 75.3% of those with CVD.ConclusionsOver 60% of recent-onset PD patients have high or medium cardiovascular risk (meriting statin usage), which is associated with a worse motor and cognitive phenotype. Statins are underused in these patients, compared with those with vascular disease, which is a missed opportunity for preventive treatment.Trial Registration NumberGN11NE062, NCT02881099.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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