Does Statin Use Reduce Psychiatric Hospitalizations and Emergency Room Visits?

 

A new paper out this week led by my colleague, Dr. Teo Postolache raises the intriguing question as to whether patients prescribed statins have lower rates of psychiatric based hospital admissions as compared to non-statin users.  The rationale for this study was based on prior work suggesting that statins not only slow cognitive decline and reduce the risk dementia but also decrease hospitalization rates as much as 25% in men and women with a history of major depression.  Additional support for statin use includes inherent beneficial effects on oxidative stress, neuroinflammation and immune function, all of which that are commonly aggravated in psychiatric illnesses.

In the current study of ~680,000 Veterans with a history of schizophrenia or bipolar disorder studied, statin use was associated with a 15-30% lower likelihood of psychiatrically based hospitalization and emergency room visits.  While this study cannot prove cause-effect (that is, statin use being directly implicated in lowering hospitalization rates) it does support further investigation testing various statins -including those that dissolve in fat (lipophilic) or do not (hydrophilic) – and monitoring hospitalization rates between randomization of assigned statin and the prespecified follow-up period.

Listed below are additional considerations related to psychiatric illness and cardiovascular disease.

1. Adults with major depressive illness experience a 15-25% increased risk of heart attacks, cardiovascular death and all-cause mortality compared to those without depression.
2. Optimism is associated with a 35% lower risk of future heart attack, stroke or death from heart disease.
3. Serious mental illness (schizophrenia, bipolar disorder, major depression) is associated with a 78% increased risk of future cardiovascular events (heart attack/stroke) than those without mental illness.
4. Serious mental illness is also associated with a 2-fold increased risk of cardiovascular death. A comprehensive risk reduction program (IDEAL trial) is underway to assess whether innovative interventions can reduce risk.
5. A Japanese study found that rarely or never laughing was associated with a 20% higher risk of heart disease and 60% higher risk of stroke compared to those who laughed daily.
6. A new study finds robust evidence that statins are unlikely to lead to depressive symptoms in the general population.
7. A recent analysis of more than 500,000 men and women found no association between statin use and ALS (amyotrophic lateral sclerosis) or Lou Gehrig’s disease.
8. Statins have no significant adverse effect on sleep duration and efficiency.  In fact, statins significantly reduce wake time and number of awakenings.
9. Statin treatment is not related to cataract development or progression.
10. There is no good evidence to suggest that statins increase the risk of tendonitis or tendon rupture.
11. There is no need to avoid statin therapy in patients with stable chronic liver disease and normal or modestly elevated transaminases (up to 3 times the ULN).
12. At the present time, however, there is no conclusive evidence for a causal relationship between statin treatment and peripheral neuropathy.

 

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1