Official Title: “Do HMG CoA Reductase Inhibitors Affect Abeta Levels?”

Recent evidence suggests that there is a significant overlap between AD and cerebrovascular disease. In fact, AD and cerebrovascular disease may share some of the same risk factors, including hypercholesterolemia. In addition, studies have suggested that the HMG Co-A reductase inhibitor lipid-lowering agents, known as "statins," decrease the risk of AD by up to 70%; however, effects differed by specific statin use. This study will compare two statins, simvastatin (which crosses the blood brain barrier) and pravastatin (which does not), with respect to their ability to alter blood and cerebrospinal fluid (CSF) levels of AD and inflammatory markers. The primary aim of the proposed study is to determine whether there is a reduction in Abeta with statins and whether the ability of the statin to cross the blood-brain barrier will affect its ability to decrease Abeta. If it can be demonstrated that statins alter AD-associated biomarkers, this would have broad implications for the treatment and prevention of AD.

Study Type: Interventional

Study Design: Prevention, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Active Control, Parallel Assignment

Study Primary Completion Date: April 2005

Recent evidence suggests that there is a significant overlap between AD and cerebrovascular disease. In fact, AD and cerebrovascular disease may share some of the same risk factors, including hypercholesterolemia. In addition, studies have suggested that the HMG Co-A reductase inhibitor lipid-lowering agents, known as "statins," decrease the risk of AD by up to 70%; however, effects differed by specific statin use. This study will compare two statins, simvastatin (which crosses the blood brain barrier) and pravastatin (which does not), with respect to their ability to alter blood and cerebrospinal fluid (CSF) levels of AD and inflammatory markers. The primary aim of the proposed study is to determine whether there is a reduction in Abeta with statins and whether the lipophilicity of the statin will affect its ability to decrease Abeta. In addition, the proposal will determine statin effects on both peripheral and central inflammation and whether the lipophilicity of the statin will affect its ability to decrease inflammation. If it can be demonstrated that statins alter AD-associated biomarkers, this would have broad implications for the treatment and prevention of AD.

This study will be performed in 60 cognitively normal middle-aged and older persons with hypercholesterolemia (total cholesterol >200 and/or LDL>130), presumably persons that have a lipid-related increased risk of AD and in whom alterations of CSF Abeta can be interpreted.The differential effects of the two statins will be evaluated in a 12-week randomized treatment trial with 30 subjects in each group.

Prior to randomization and following 12 weeks of treatment with simvastatin or pravastatin, subjects will undergo CSF and blood collection. In the CSF, concentrations of Abeta 1-40, Abeta 1-42, soluble APP, tau, 24S-hydroxycholesterol, apoE, total cholesterol, F2-isoprostanes, glucose, protein, and cell count will be measured. In the blood, concentrations of total cholesterol, HDL, LDL, triglyceride, phospholipids, fatty acids, 24S-hydroxycholesterol, apoE, apoB, apoA1, Abeta 1-40, Abeta 1-42, F2-isoprostanes, C-reactive protein, fibrinogen, iron, homocysteine, and albumin will be measured. Plasma simvastatin and pravastatin concentrations will be measured at study completion. APOE genotyping will be performed.

Intervention(s) in this Clinical Trial

• Drug: simvastatin
  • simvastatin 40 mg tablets once per day for 12 weeks
• Drug: pravastatin
  • pravastatin 80 mg tablets once per day for 12 weeks

Arms, Groups and Cohorts in this Clinical Trial

• Active Comparator: 1
  • simvastatin
• Active Comparator: 2
  • pravastatin

Primary Measures

• CSF abeta levels
  • Time Frame: baseline and 12 weeks
    Safety Issue?: No

Secondary Measures

• CSF biomarkers
  • Time Frame: baseline and 12 weeks
    Safety Issue?: No

Inclusion Criteria:

• Total cholesterol > 200, and/or LDL > 130
• No cognitive impairment
• Statin-naive for at least one year
• Women must not be pregnant, nursing, or planning to become pregnant

Exclusion Criteria:

• Back ailments which would hinder LP procedure
• Neurological disease, including stroke, Parkinson's disease, Multiple Sclerosis, uncontrolled epilepsy, history of severe head trauma
• Hepatic disease
• Renal insufficiency
• Unstable medical disease
• Severe pulmonary disease
• Severe cardiac disease
• Uncontrolled hypertension (greater than 160/90)
• Uncontrolled hyper/hypothyroidism
• History of blood clotting abnormalities or platelet abnormalities
• History of chronic major psychiatric disorders or presence of current major depressive disorder (by DSM-IV criteria)
• History of substance abuse within the past year
• Taking exclusionary medications

Gender Eligibility for this Clinical Trial: Both

Minimum Age for this Clinical Trial: 18 Years

Maximum Age for this Clinical Trial: 90 Years

Are Healthy Volunteers Accepted for this Clinical Trial?: No

Lead Sponsor: Seattle Institute for Biomedical and Clinical Research

Overall Clinical Trial Officials and Contacts

Elaine R Peskind, MD Principal Investigator University of Washington  

Information obtained from ClinicalTrials.gov on July 02, 2009

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00303277

Study ID Number: 21974

ClinicalTrials.gov Identifier: NCT00303277

Health Authority: United States: Institutional Review Board