# Statin treatment for cerebral small vessel disease: A systematic review and meta-analysis of randomized controlled trials

## TL;DR

Statin treatment may reduce brain white matter damage, but evidence is limited and more research is needed to understand its effects on cognitive and functional outcomes.

## Contribution

A systematic review and meta-analysis of randomized trials on statin use for cerebral small vessel disease.

## Key findings

- A non-significant trend toward reduced white matter hyperintensity volume in the statin group.
- Current evidence for statin treatment in cerebral small vessel disease is limited.
- Future studies should focus on clinical and patient-centered outcomes, not just imaging results.

## Abstract

•Statins may reduce white matter hyperintensities on brain imaging although current evidence is limited.•The mechanisms behind the possible effect of statins for cerebral small vessel disease are not yet known.•Future studies are needed and should focus on patient-centered and clinical outcomes and not exclusively on radiological outcomes.

Statins may reduce white matter hyperintensities on brain imaging although current evidence is limited.

The mechanisms behind the possible effect of statins for cerebral small vessel disease are not yet known.

Future studies are needed and should focus on patient-centered and clinical outcomes and not exclusively on radiological outcomes.

Cerebral small vessel disease (CSVD) is a chronic, progressive disorder that affects small blood vessels in the brain's white matter. This white matter damage appears on brain imaging as white matter hyperintensities (WMH). Although CSVD is often asymptomatic, it causes one fifth of strokes and nearly half of all vascular dementia cases, highlighting its clinical importance. Statins, widely used to lower lipid levels, are effective for reducing cardiovascular mortality in high-risk groups and are recommended for patients with myocardial infarction and ischemic stroke.

This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the impact of statin therapy on CSVD.

A literature search was performed in PubMed, Embase, the Cochrane Library and Epistemonikos resulting in the full-text review of 86 articles, of which two were used for the meta-analysis.

A non-significant trend towards lower WMH volume in milliliters was observed in the statin group compared to controls, mean difference (MD) = -4.44 (95 % CI -10.19–1.31).

There is limited evidence available for the use of stain-treatment for CSVD, and further research is needed as well as studies on the clinical and person-centered benefits of statins on cognition and functional level in persons with CSVD.