重度抑郁症（MDD）和抗抑郁药物在高剂量他汀类药物治疗中所占比例过高。
Major Depressive Disorder (MDD) and Antidepressant Medication Are Overrepresented in High-Dose Statin Treatment.
作者信息
Leutner Michael, Matzhold Caspar, Kautzky Alexander, Kaleta Michaela, Thurner Stefan, Klimek Peter, Kautzky-Willer Alexandra
机构信息
Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Section for Science of Complex Systems, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.
出版信息
Front Med (Lausanne). 2021 Feb 11;8:608083. doi: 10.3389/fmed.2021.608083. eCollection 2021.
To examine the dose-dependent relationship of different types of statins with the occurrence of major depressive disorder (MDD) and prescription of antidepressant medication. This cross-sectional study used medical claims data for the general Austrian population ( = 7,481,168) to identify all statin-treated patients. We analyzed all patients with MDD undergoing statin treatment and calculated the average defined daily dose for six different types of statins. In a sub-analysis conducted independently of inpatient care, we investigated all patients on antidepressant medication (statin-treated patients: = 98,913; non-statin-treated patients: = 789,683). Multivariate logistic regression analyses were conducted to calculate the risk of diagnosed MDD and prescription of antidepressant medication in patients treated with different types of statins and dosages compared to non-statin-treated patients. In this study, there was an overrepresentation of MDD in statin-treated patients when compared to non-statin-treated patients (OR: 1.22, 95% CI: 1.20-1.25). However, there was a dose dependent relationship between statins and diagnosis of MDD. Compared to controls, the ORs of MDD were lower for low-dose statin-treated patients (simvastatin>0- < =10 mg:OR: 0.59, 95% CI: 0.54-0.64; atorvastatin>0- < =10 mg:OR:0.65, 95%CI: 0.59-0.70; rosuvastatin>0- < =10 mg:OR: 0.68, 95% CI: 0.53-0.85). In higher statin dosages there was an overrepresentation of MDD (simvastatin>40- < =60 mg:OR: 2.42, 95% CI: 2.18-2.70, >60-80 mg:OR: 5.27, 95% CI: 4.21-6.60; atorvastatin>40- < =60 mg:OR: 2.71, 95% CI: 1.98-3.72, >60- < =80 mg:OR: 3.73, 95% CI: 2.22-6.28; rosuvastatin>20- < =40 mg:OR: 2.09, 95% CI: 1.31-3.34). The results were confirmed in a sex-specific analysis and in a cohort of patients taking antidepressants, prescribed independently of inpatient care. This study shows that it is important to carefully re-investigate the relationship between statins and MDD. High-dose statin treatment was related to an overrepresentation, low-dose statin treatment to an underrepresentation of MDD.
研究不同类型他汀类药物与重度抑郁症（MDD）发生及抗抑郁药物处方之间的剂量依赖关系。这项横断面研究利用奥地利普通人群的医疗索赔数据（n = 7,481,168）来识别所有接受他汀类药物治疗的患者。我们分析了所有接受他汀类药物治疗且患有MDD的患者，并计算了六种不同类型他汀类药物的平均限定日剂量。在一项独立于住院治疗进行的亚分析中，我们调查了所有服用抗抑郁药物的患者（接受他汀类药物治疗的患者：n = 98,913；未接受他汀类药物治疗的患者：n = 789,683）。进行多变量逻辑回归分析，以计算与未接受他汀类药物治疗的患者相比，接受不同类型他汀类药物和剂量治疗的患者被诊断为MDD及开具抗抑郁药物处方的风险。在本研究中，与未接受他汀类药物治疗的患者相比，接受他汀类药物治疗的患者中MDD的比例过高（比值比：1.22，95%置信区间：1.20 - 1.25）。然而，他汀类药物与MDD诊断之间存在剂量依赖关系。与对照组相比，低剂量他汀类药物治疗的患者患MDD的比值比更低（辛伐他汀>0 - ≤10 mg：比值比：0.59，95%置信区间：0.54 - 0.64；阿托伐他汀>0 - ≤10 mg：比值比：0.65，95%置信区间：0.59 - 0.70；瑞舒伐他汀>0 - ≤10 mg：比值比：0.68，95%置信区间：0.53 - 0.85）。在较高剂量的他汀类药物治疗中，MDD的比例过高（辛伐他汀>40 - ≤60 mg：比值比：2.42，95%置信区间：2.18 - 2.70，>60 - 80 mg：比值比：5.27，95%置信区间：4.21 - 6.60；阿托伐他汀>40 - ≤60 mg：比值比：2.71，95%置信区间：1.98 - 3.72，>60 - ≤80 mg：比值比：3.73，95%置信区间：2.22 - 6.28；瑞舒伐他汀>20 - ≤40 mg：比值比：2.09，95%置信区间：1.31 - 3.34）。在按性别进行的分析以及一组独立于住院治疗开具抗抑郁药物的患者队列中，结果得到了证实。这项研究表明，仔细重新研究他汀类药物与MDD之间的关系很重要。高剂量他汀类药物治疗与MDD比例过高相关，低剂量他汀类药物治疗与MDD比例过低相关。
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