Yang Chen-Chang, Jick Susan S, Jick Hershel
Department of Internal Medicine, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Arch Intern Med. 2003 Sep 8;163(16):1926-32. doi: 10.1001/archinte.163.16.1926.
A possible association between lipid-lowering drug therapy and psychological well-being remains an issue of debate. To provide more information, we performed a nested case-control study to evaluate the effect of lipid-lowering drugs on depression and suicidal behavior.
Within the United Kingdom General Practice Research Database, we identified all cases with newly treated depression needing a referral or hospitalization and all cases with first-recorded diagnosis of suicidal behavior between January 1, 1991, and December 31, 1999, from a study base that comprised all patients who were aged between 40 and 79 years and who had various exposures of interest. Each case was matched with up to 4 controls, randomly selected from the study base, on age, sex, medical practice, calendar time, and years since enrollment in the General Practice Research Database.
A nested case-control analysis comprised 458 newly diagnosed cases of depression with 1830 controls, and 105 cases of suicidal behavior with 420 controls. The adjusted odds ratio of depression was 0.4 (95% confidence interval, 0.2-0.9) for current statin use, compared with hyperlipidemic nonuse. The adjusted odds ratios for other exposures were all around 1.0. None of the adjusted odds ratios for suicidal behavior were significantly different from unity.
The use of statins and other lipid-lowering drugs is not associated with an increased risk of depression or suicide. On the contrary, individuals with current statin use may have a lower risk of developing depression, an effect that could be explained by improved quality of life due to decreased risk of cardiovascular events or more health consciousness in patients receiving long-term treatment.
降脂药物治疗与心理健康之间可能存在的关联仍是一个有争议的问题。为了提供更多信息，我们进行了一项巢式病例对照研究，以评估降脂药物对抑郁和自杀行为的影响。
在英国全科医疗研究数据库中，我们从一个研究库中识别出1991年1月1日至1999年12月31日期间所有新治疗的需要转诊或住院的抑郁症病例以及所有首次记录诊断为自杀行为的病例，该研究库包括所有年龄在40至79岁之间且有各种感兴趣暴露因素的患者。每个病例与最多4名对照进行匹配，这些对照从研究库中随机选取，匹配因素包括年龄、性别、医疗实践、日历时间以及加入全科医疗研究数据库后的年限。
一项巢式病例对照分析包括458例新诊断的抑郁症病例及1830名对照，以及105例自杀行为病例及420名对照。与未使用降脂药物的高脂血症患者相比，当前使用他汀类药物的患者发生抑郁的校正比值比为0.4（95%置信区间，0.2 - 0.9）。其他暴露因素的校正比值比均在1.0左右。自杀行为的所有校正比值比与1均无显著差异。
使用他汀类药物和其他降脂药物与抑郁或自杀风险增加无关。相反，当前使用他汀类药物的个体发生抑郁的风险可能较低，这一效应可能是由于心血管事件风险降低导致生活质量改善，或者是接受长期治疗的患者健康意识增强所致。
