Golomb Beatrice Alexandra, Criqui Michael H, White Halbert, Dimsdale Joel E
Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
Arch Intern Med. 2004 Jan 26;164(2):153-62. doi: 10.1001/archinte.164.2.153.
Statin cholesterol-lowering drugs are among the most prescribed drugs in the United States. Their cardiac benefits are substantial and well supported. However, there has been persistent controversy regarding possible favorable or adverse effects of statins or of cholesterol reduction on cognition, mood, and behavior (including aggressive or violent behavior).
The literature pertaining to the relationship of cholesterol or statins to several noncardiac domains was reviewed, including the link between statins (or cholesterol) and cognition, aggression, and serotonin.
There are reasons to think both favorable and adverse effects of statins and low cholesterol on cognition may pertain; the balance of these factors requires further elucidation. A substantial body of literature links low cholesterol level to aggressive behavior; statin randomized trials have not supported a connection, but they have not been designed to address this issue. A limited number of reports suggest a connection between reduced cholesterol level and reduced serotonin level, but more information is needed with serotonin measures that are practical for clinical use. Whether lipophilic and hydrophilic statins differ in their impact should be assessed.
There is a strong need for randomized controlled trial data to more clearly establish the impact of hydrophilic and lipophilic statins on cognition, aggression, and serotonin, as well as on other measures relevant to risks and quality-of-life impact in noncardiac domains.
他汀类降胆固醇药物是美国处方量最大的药物之一。它们对心脏的益处显著且有充分依据。然而，关于他汀类药物或胆固醇降低对认知、情绪和行为（包括攻击或暴力行为）可能产生的有利或不利影响，一直存在争议。
回顾了与胆固醇或他汀类药物与几个非心脏领域关系相关的文献，包括他汀类药物（或胆固醇）与认知、攻击行为和血清素之间的联系。
有理由认为他汀类药物和低胆固醇对认知可能既有有利影响也有不利影响；这些因素的平衡需要进一步阐明。大量文献将低胆固醇水平与攻击行为联系起来；他汀类药物随机试验并未支持这种关联，但这些试验并非旨在解决这一问题。少数报告表明胆固醇水平降低与血清素水平降低之间存在联系，但对于临床实用的血清素测量方法，还需要更多信息。亲脂性他汀类药物和亲水性他汀类药物的影响是否存在差异应予以评估。
迫切需要随机对照试验数据，以更清楚地确定亲水性他汀类药物和亲脂性他汀类药物对认知、攻击行为和血清素的影响，以及对非心脏领域与风险和生活质量影响相关的其他指标的影响。
