Chintan V Dave1, Almut G Winterstein2, Haesuk Park2, Robert L Cook3, Abraham G Hartzema2. 1. Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA. Electronic address: cdave@bwh.harvard.edu. 2. Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA. 3. Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
Abstract
OBJECTIVES: To evaluate the risk of new-onset depression in a cohort of US adult patients initiating lipophilic statin therapy compared to hydrophilic statin therapy. DESIGN: Retrospective cohort study. SETTING: Large US commercial claims database PARTICIPANTS: 1:1 propensity score matched cohort of lipophilic (atorvastatin, lovastatin and simvastatin) and hydrophilic (pravastatin and rosuvastatin) statin initiators between January 2009 to June 2015. OUTCOME: New onset of depression. RESULTS: In a propensity-score matched cohort of 299,298 statin initiators, the crude incidence of depression in the hydrophilic and lipophilic group was 136.6 and 142.8 per 10,000 person-years respectively. Compared to hydrophilic statin use, lipophilic statin use was not associated with a statistically significant increase in the risk of depression, adjusted HR 1.05 (95% CI, 1.00-1.10, p = 0.078) and excess incidence of 6.3 (95% CI, -0.7-13.7) per 10,000 person-years. Findings were consistent across the subgroups of patients with history of psychiatric conditions HR 1.05 (95% CI, 0.94-1.16, p = 0.41), and those initiating statins for primary or secondary prevention, HR 1.03 (95% CI, 0.97-1.10, p = 0.33) and 1.07 (95% CI, 0.99-1.16, p = 0.10) respectively. Within individual lipophilic statins, only simvastatin was associated with a moderate increase in the risk of depression HR 1.09 (95% CI, 1.02-1.16, p = 0.003), followed by lovastatin HR 1.07 (95% CI, 0.93-1.24, p = 0.34) and atorvastatin HR 1.05 (95% CI, 0.97-1.13, p = 0.27). LIMITATIONS: Findings are generalizable to patients with commercial insurance. CONCLUSIONS: Lipophilic statin use was not associated with a significant increase in the risk of incident depression.
OBJECTIVES: To evaluate the risk of new-onset depression in a cohort of US adult patients initiating lipophilic statin therapy compared to hydrophilic statin therapy. DESIGN: Retrospective cohort study. SETTING: Large US commercial claims database PARTICIPANTS: 1:1 propensity score matched cohort of lipophilic (atorvastatin, lovastatin and simvastatin) and hydrophilic (pravastatin and rosuvastatin) statin initiators between January 2009 to June 2015. OUTCOME: New onset of depression. RESULTS: In a propensity-score matched cohort of 299,298 statin initiators, the crude incidence of depression in the hydrophilic and lipophilic group was 136.6 and 142.8 per 10,000 person-years respectively. Compared to hydrophilic statin use, lipophilic statin use was not associated with a statistically significant increase in the risk of depression, adjusted HR 1.05 (95% CI, 1.00-1.10, p = 0.078) and excess incidence of 6.3 (95% CI, -0.7-13.7) per 10,000 person-years. Findings were consistent across the subgroups of patients with history of psychiatric conditions HR 1.05 (95% CI, 0.94-1.16, p = 0.41), and those initiating statins for primary or secondary prevention, HR 1.03 (95% CI, 0.97-1.10, p = 0.33) and 1.07 (95% CI, 0.99-1.16, p = 0.10) respectively. Within individual lipophilic statins, only simvastatin was associated with a moderate increase in the risk of depression HR 1.09 (95% CI, 1.02-1.16, p = 0.003), followed by lovastatin HR 1.07 (95% CI, 0.93-1.24, p = 0.34) and atorvastatin HR 1.05 (95% CI, 0.97-1.13, p = 0.27). LIMITATIONS: Findings are generalizable to patients with commercial insurance. CONCLUSIONS: Lipophilic statin use was not associated with a significant increase in the risk of incident depression.
Authors: Bruno Agustini; Mohammadreza Mohebbi; Robyn L Woods; John J McNeil; Mark R Nelson; Raj C Shah; Anne M Murray; Michael E Ernst; Christopher M Reid; Andrew Tonkin; Jessica E Lockery; Michael Berk Journal: CNS Drugs Date: 2019-07 Impact factor: 5.749
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