Vascular dementia: New molecular therapies on the rise?

Studies show a causal relationship between different risk factors and microangiopathies, one of the main causes of vascular dementia. They also shed light on the effectiveness of therapeutic approaches.

Novel statistical studies bring innovative therapeutic approaches

Studies using Mendelian randomization have shown that there is a causal relationship between different risk factors and microangiopathies, one of the main causes of vascular dementia. New findings have also been made with regard to the effectiveness of different therapeutic approaches.

Vascular disease alone or as a co-pathology is responsible for 40% of dementia diseases. The risk factors do not differ from the classic vascular risk profile, many of them are related to individual lifestyles and can be modified, others are genetic and an important starting point for new therapies.

For the diagnosis and prognosis of central vascular pathologies, two surrogate markers in particular (measured value to assess the effectiveness of an intervention in clinical studies) have proven to be effective:

Review of known risk factors using Mendelian randomisation

Using Mendelian randomisation, new causal relationships between some known risk factors and the outcome of vascular disease have also been shown, as well as the efficacy of certain drugs. This statistical method can be used to investigate causal influences on certain diseases in non-experimental studies.

Microangiopathies are one of the main causes of vascular pathologies and genetic elevated blood pressure is one of the major risk factors for all forms of stroke. It has been shown that mean systolic blood pressure increases the risk, but not increased pulse pressure. The effect of different antihypertensive drugs on stroke risk - ACE inhibitors, beta-blockers and calcium channel blockers - was also studied. The latter were the only ones that had a proven reducing effect on vascular events.

Subtype of HDL protects against stroke

The effect of lipoproteins on the risk of stroke was also studied. Increased HDL-C levels showed a protective effect on vascular events, in this case small vessel disease (SVD) and the volume of white matter hyperintensity (WMH). A more detailed analysis of the subforms showed that M-HDL-C alone, but not L- and XL-HDL-C, is responsible for this risk reduction. This was followed by an investigation into the protective effect of HDL-increasing and LDL-lowering drugs. A protective effect of CETP (cholesteryl ester transfer protein) inhibitors was demonstrated.

Conclusion

Source:
Prof. Dr. med. M. Dichgans, Institute for Stroke and Dementia Research (ISD) at the LMU Klinikum University Hospital in Munich, Germany. DGN 2020, 04.11.2020

Esanum is an online network for approved doctors

Esanum is the medical platform on the Internet. Here, doctors have the opportunity to get in touch with a multitude of colleagues and to share interdisciplinary experiences. Discussions include both cases and observations from practice, as well as news and developments from everyday medical practice.

Esanum ist ein Online-Netzwerk für approbierte Ärzte

Esanum ist die Ärzteplattform im Internet. Hier haben Ärzte die Möglichkeit, mit einer Vielzahl von Kollegen in Kontakt zu treten und interdisziplinär Erfahrungen auszutauschen. Diskussionen umfassen sowohl Fälle und Beobachtungen aus der Praxis, als auch Neuigkeiten und Entwicklungen aus dem medizinischen Alltag.

Esanum est un réseau en ligne pour les médecins agréés

Esanum est un réseau social pour les médecins. Rejoignez la communauté et partagez votre expérience avec vos confrères. Actualités santé, comptes-rendus d'études scientifiques et congrès médicaux : retrouvez toute l'actualité de votre spécialité médicale sur esanum.