Deep thoughts on lipids and cognition

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Statin benefits on cardiovascular risk reduction appear proportional to the degree of LDL cholesterol (LDL-C) reduction. Despite prior arguments that pleiotropic effects were responsible for the greater therapeutic impact of the statin class [1], recent trials of adjunctive therapy to statins have only further supported LDL lowering as the principle therapeutic mechanism [2,3]. Adding these new drug classes, the most impactful of which may be the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, to statins facilitate the achievement of extremely low LDL-C levels. As cholesterol plays a crucial role in brain development, there has been growing concern regarding the adverse effects of the low LDL-C achieved by these drugs [4▪]. Adverse neurocognitive effects have been of keen interest given the progressive increase in life expectancy worldwide and came to the forefront following the Food and Drug Administration report raising concern for statin-related ‘ill-defined memory loss or impairment’ in 2012 [5].
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