1. Medications and cognitive decline in Alzheimer's disease : Cohort cluster analysis of 15,428 patientsPol Grau-Jurado, Shayan Mostafaei, Hong Xu, Minjia Mo, Bojana Petek, Irena Kalar, Luana Naia, Julianna Kele, Silvia Maioli, Joana Carvalho, Maria Eriksdotter Jönhagen, Saikat Chatterjee, Sara Garcia-Ptacek, 2025, original scientific article Abstract: BackgroundMedications for comorbid conditions may affect cognition in Alzheimer's disease (AD). ObjectiveTo explore the association between common medications and cognition, measured with the Mini-Mental State Examination. MethodsCohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters. Results15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15–1.83] at first follow-up, simvastatin (1.41 [1.11–1.78] at second follow-up), warfarin (1.56 [1.22–2.01] first follow-up), zopiclone (1.35 [1.15–1.58], and metformin (2.08 [1.35–3.33] second follow-up. Oxazepam (0.60 [0.50–0.73] first follow-up), paracetamol (0.83 [0.73–0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia. ConclusionsWe performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.
Keywords: Alzheimer's disease, cohort study, comorbidity, metformin, Mini-Mental State Examination, oxazepam, pharmacological treatments, statins, warfarin, zopiclone
Published in DiRROS: 15.04.2026; Views: 170; Downloads: 168
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2. Suboptimal management of hypercholesterolemia in countries with high or very high cardiovascular risk : findings from the international DISCOVERY studyMišo Šabovič, Hristo Pejkov, Alexandru Caraus, Ivan Gruev, Vlad Damian Vintilă, Zoltán Csanádi, Sodgerel Batjargal, Tamara Kovačević -Preradović, Zumreta Kusljugić, Draško Kuprešak, 2025, original scientific article Abstract: Introduction: The 2019 ESC/EAS guidelines introduced stricter low-density lipoprotein cholesterol (LDL-C) targets, particularly for patients at high and very high cardiovascular (CV) risk. However, data on the implementation of these targets in real-world clinical practice—especially in countries with high/very high CV risk—remain limited. The DISCOVERY study aimed to assess LDL-C management, lipid-lowering therapy (LLT) use, and guideline adherence across multiple countries in Central and Eastern Europe and Central Asia. Methods: This prospective, observational, multicenter study enrolled adult patients with hypercholesterolemia (HCL) from 10 countries grouped into three regions. Data was collected at baseline and after 12 weeks of follow-up. LLT patterns, LDL-C levels, target attainment (both investigator-defined and 2019 ESC/EAS-recommended), and physician adherence to guidelines were analyzed. Results: A total of 6,447 patients were included; 53.2% were female, and the mean age was 60.5 ± 11.9 years. Most patients (66%) were in secondary prevention. At baseline, 36.8% had been treated with LLT. After the first visit, treatment was changed in 78% of patients, but only 42.4% received highintensity statins and 9.3% received statin-ezetimibe combinations at followup. LDL-C target achievement was poor: only 5.6% of patients met the guideline-recommended LDL-C goals, compared to 45.5% who met physician-defined targets. Among patients with ASCVD, only 3.3% achieved guideline LDL-C targets. The most significant gap was observed between guideline recommendations and physician-set LDL-C goals. No significant difference in LDL-C target attainment was observed between specialists and general practitioners. Discussion: The DISCOVERY study reveals suboptimal LDL-C control and low adherence to the 2019 ESC/EAS guidelines in routine practice across countries with high/very high CV risk. These findings highlight the urgent need for strategies to improve physician awareness, promote intensive LLT use, and close the gap between guidelines and clinical practice. A paradigm shift toward proactive LDL-C management is essential to reduce residual CV risk in these populations.
Keywords: LDL-C, hypercholesterolemia, lipid-lowering therapy, ESC/EAS guidelines, cardiovascular risk, real-world evidence, statins, ezetimibe
Published in DiRROS: 31.03.2026; Views: 267; Downloads: 152
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