Combination statin therapy can lower LDL cholesterol by nearly 70% in patients at high risk of coronary heart disease; it also may reduce inflammation that can lead to heart disease or stroke. A study published in the March 1 American Journal of Cardiology randomized 469 patients to receive 40 mg of rosuvastatin alone or with 10 mg of ezetimibe for six weeks. The Adult Treatment Panel III LDL cholesterol goal of less than 100 mg/dL was met by 94% of the combination therapy patients, significantly more than the 79% of monotherapy patients; an optional goal of 70 mg/dL for very-high-risk patients was met by nearly 80% of those who received both drugs, compared with 35% of those receiving only rosuvastatin. Combination treatment also reduced LDL cholesterol significantly more than did monotherapy (by 69.8% and 57.1%, respectively).

Adverse events and treatment errors in stroke patients occur frequently, according to a study published in the February 20 Neurology. One hundred seventy-three (12%) of 1,440 stroke patients admitted to a single medical center over 3.5 years reported a total of 201 unique events. Of the 183 adverse events (the other 18 were categorized as “near misses”), 86 were determined to be preventable, 37 were not preventable, and 60 were indeterminate. The preventable adverse events were most commonly transcription or documentation errors (37%), failure to perform a clinical task (23%), communication or handoff errors between providers (10%), and failed independent checks or calculations (10%). The researchers suggested a disease-specific approach to analyzing spontaneously reported events to improve the quality of care.

Increased cholesterol levels in women, particularly LDL cholesterol, are significantly associated with risk of ischemic stroke, as reported in the February 20 Neurology. The prospective cohort study of 27,937 women 45 and older, who provided blood samples at baseline, self-reported 282 strokes over the 11-year follow- up period. Increased levels of all lipids were strongly associated with increased risk of ischemic stroke after adjustment for age, though the researchers noted that adjustment for confounders attenuated the HDL cholesterol association. Odds ratios for stroke for participants in the highest quintile of plasma lipid levels, when compared with the lowest quintile, were 2.45 for non-HDL cholesterol, 2.27 for total cholesterol, 1.74 for LDL cholesterol, 1.65 for the ratio of total cholesterol to HDL cholesterol, and 0.78 for HDL cholesterol.

Hsp90 inhibitor EC102 was observed to reduce the levels of protein tau in the brains of mice exhibiting Alzheimer’s disease–like tangles, reported researchers in the March Journal of Clinical Investigation. When Hsp90 was prevented from refolding into a protein complex, the ubiquitin ligase carboxy terminus of Hsp70-interacting protein (CHIP) was able to recognize the hyperphosphorylated tau and degrade it, said the authors. Besides being effective at degrading the tau aggregations, they also noted that EC102 is able to permeate the blood-brain barrier. “When taken in the context of known high-affinity Hsp90 complexes in affected regions of the [Alzheimer’s disease] brain, these data implicate a central role for Hsp90 in the development of [Alz­heimer’s disease] and other tauopathies and may provide a rationale for the development of novel Hsp90-based therapeutic strategies,” stated the authors.

Serum antibodies against two my­elin proteins are not associated with an increased risk of multiple sclerosis (MS) progression in patients who have had an isolated incidence of neurologic dysfunction, reported researchers in the January 25 New England Journal of Medicine. Antibodies to myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP) were measured at baseline by Western blot in 462 patients with a first clinical event suggestive of MS and at least two clinically silent lesions on brain MRI; assessment of neurologic impairment and MRI were conducted before treatment with interferon beta-1b and at months 3, 6, 9, 12, 18, and 24. The researchers reported that no associations were found between the presence of anti-MOG and anti-MBP antibodies and the time and rate of progression to clinically definite MS or diagnosis of MS by McDonald criteria.

Presence of a risk gene for Alzheimer’s disease does not appear to have cognitive effects early in a carrier’s life span, according to research in the January Neuropsychology. The researchers examined the relationship between the presence of the apo­lipoprotein E (APOE) e4 allele and cognitive function in a population sample of 6,560 white participants ages 20 to 24, 40 to 44, and 60 to 64. The results of tests on episodic memory, working memory, mental speed, and reaction time declined across the age-groups, though there were no effects of the APOE e4 allele at any age. Therefore, the researchers concluded, “Cognitive aging effects between the ages of 20 and 64 years must not be due to preclinical Alzheimer’s disease.”

Researchers have identified a new protein that they believe controls production of b-amyloid in the brains of Alzheimer’s disease patients. Previous studies have described increased casein kinase 1 (CK1) expression in persons with Alzheimer’s disease, they said; however, as reported in the March 6 Proceedings of the National Academy of Sciences, the researchers were able to significantly reduce the production of endogenous b-amyloid by inhibiting CK1 in modified mouse cells in vitro. They also stated that Notch cleavage, which is important in the development of healthy brain cells, was not blocked— a side effect that occurs with current drugs that aim to halt b-amyloid production. “Our results indicate that CK1 represents a therapeutic target for prevention of [b-amyloid] formation in AD,” they concluded.

Advice to expectant mothers in the United States to limit their sea­food intake may put the unborn child at a higher risk for suboptimal neurodevelopmental outcomes, according to a study in the February 17 Lancet. A total of 11,875 women completed food frequency questionnaires at 32 weeks’ gestation; those who reported consuming less than 340 grams of seafood per week had greater odds of having a child in the lowest quartile for IQ at age 8, compared with women who ate more than the recommended amount (odds ratios, 1.48 for women who ate no seafood, and 1.09 who ate between 1 and 340 grams per week). Suboptimal prosocial behavior, fine motor, communication, and social development scores were also associated with lower maternal seafood intake.

Omega-3 fatty acid intake may be associated with gray matter volume, reported researchers at the 65th Annual Scientific Conference of the American Psychosomatic Society in Budapest. They interviewed 55 healthy adults regarding average intake of long-chain omega-3 fatty acids and observed that participants who reported high levels of omega-3 intake had greater volumes of gray matter in the bilateral anterior cingulate cortex, the right amygdala, and the right hippocampus, as determined by high-resolution structural MRI. The research­ers noted that the improvements were observed in areas of the brain related to mood and regulation of emotion, in which gray matter is decreased in persons with mood disorders; however, they said that more research is needed to determine whether fish consumption actually causes the changes.

Antidepressant treatment may increase long-term improvement of executive function in stroke patients, according to a study in the March British Journal of Psychiatry. Forty-seven patients who had experienced a stroke within the prior six months were randomized to receive 12 weeks of antidepressant treatment (fluoxetine or nortriptyline) or placebo; function was assessed using standard neuropsychological tasks at the end of treatment and two years after the start of the study. The researchers reported no significant differences at 12 weeks; however, the long-term follow-up examination of 36 patients revealed that the placebo group experienced deterioration of executive function, while the active treatment group “showed clear and significant improvement independent of depressive symptoms,” according to the authors. They suggested that the antidepressants foster the process of neural tissue reorganization poststroke.

NR