Neuropsychiatric outcomes with statins
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Neuropsychiatric outcomes with statins There does not appear to be an association between the use of HMG-CoA reductase inhibitors (statins) and the neuropsychiatric outcomes of suicidality, seizures or anxiety, according to the results of a large population-based study reported in Lancet Psychiatry, but there may be a reduced risk of depressive disorders. The study used national registers in Sweden to identify 1149 384 patients who used statins in 2006–2013. The most commonly prescribed statin was simvastatin (87.6%), followed by atorvastatin (21.3%), rosuvastatin (4.7%), pravastatin (3.6%) and fluvastatin (0.6%). Periods on and off statins (2997 545 vs 2053 310) were compared in the 625 616 males and 523 768 females who were ≥15 years of age. Evaluation of unplanned hospital visits or specialised outpatient care identified anxiety disorders (2.6% of patients), seizures (2.5%), depressive disorders (2.1%) and suicidality (0.6%). The incidence per 100 patient-years was 6.0, 6.1, 5.6 and 1.0, respectively. There was no statistically significant difference between periods on and off statins for anxiety disorders (hazard ratio [HR] 0.99; 95% CI 0.95, 1.02), seizures (HR 1.0; 0.97, 1.04) or suicidality (0.99; 0.90, 1.08). However, there was a significantly reduced risk of depressive disorder (HR 0.91; 0.87, 0.94), which was similar after adjusting for concurrent antidepressant treatment (HR 0.91; 0.88, 0.94). Sensitivity analyses revealed that significant reductions in the risk of depressive disorders occurred during periods of low- or moderate-dose statin use, but not during periods of high-dose use, "suggesting that there was no dose-response association", note the authors. As negative controls, the risk of depressive disorders were also calculated for thiazide users and antihistamine users, which "indicated reduces rates of depressive disorders", note the authors, "although these associations did not reach statistical significance". Consequently, "one interpretation of our findings could be that reductions in depression are explained by non-specific treatment factors rather than a direct neuroprotective effect". They conclude that "this association requires further investigation to clarify the possible contribution of non-specific treatment factors". Malero Y, et al. Associations between statin use and suicidality, depression, anxiety, and seizures: a Swedish total-population cohort study. The Lancet Psychiatry : Nov 2020. 803516441 Available from: URL: https://doi.org/10.1016/S2215-0366(20)30311-4
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Reactions 21 Nov 2020 No. 1831
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