Long-term Statin Use Reduces Atrial Fibrillation, Mood Disorders

Peggy Peck

April 02, 2003

April 2, 2003 (Chicago) — Two studies from the same group of Harvard researchers report new benefits for long-term statin therapy: a reduction in the risk for atrial fibrillation as well as protection against depression and anxiety. The results were presented here yesterday at the 52nd annual scientific session of the American College of Cardiology (ACC).

Senior investigator Charles M. Blatt, MD, assistant clinical professor of medicine at Harvard Medical School, said statin therapy significantly reduced the rate of atrial fibrillation in elderly coronary artery disease (CAD) patients. After adjustment for potential confounders such as age, alcohol use, and clinical characteristics, long-term statin therapy reduced the risk for atrial fibrillation by 63% compared with elderly CAD patients who didn't take statins, said Dr. Blatt.

In the first study, 449 patients aged 40 to 87 years were followed for an average of five years. Fifty-two of these patients developed atrial fibrillation during follow-up, said Dr. Blatt. About 60% of the cohort was receiving regular or intermittent statin therapy during follow-up. The finding "was independent of the statins' effect on lipids," but he said he could not speculate as to the mechanism.

Long-term statin therapy also reduced the risk for anxiety, depression, and hostility, Dr. Blatt said.

"When the initial statin trials were conducted, there were some reports that lowering cholesterol to very low levels was associated with violent behavior, so we decided to investigate the relationship between long-term statin use and mood disorders," Dr. Blatt said.

The results were surprising, he told Medscape. Long-term statin use was associated with a lower risk for anxiety, depression, and hostility. He said the findings suggest another pleiotropic effect of statins. "We can't really explain this effect, but it does appear to be progressive over time." Thus, the more years of statin treatment, the greater the impact on mood.

Moreover, "the effect was not seen with pravastatin, so it appears that the effect may be limited to lipophilic statins rather than hydrophilic statins," he said. There is evidence that lipophilic statins (such as simvistatin) cross the blood-brain barrier, which could explain this finding, Blatt said.

Richard Pasternak, MD, associate professor of medicine at Harvard Medical School, said "This is a striking observation and it points out once again that statins work but sometimes in ways that are unexpected." But he cautioned that there are a "host of confounders." For example, he noted that people who take statins have fewer cardiac events, which "would make them less depressed." Dr. Pasternak was not involved in the study, but he chaired the ACC press conference at which Dr. Blatt discussed the results of both studies.

In the second study, 606 patients from an outpatient cardiology clinic were recruited. The average age of patients was 67 years, and 80% were men. Patients were assessed at baseline and annually after that using the Kellner Symptom Questionnaire.

One hundred forty patients were receiving continuous statin therapy for an average follow-up of four years. Another 231 patients never used cholesterol-lowering drugs, and the remaining patients used statins intermittently.

Comparing the constant statin users to the nonusers, Dr. Blatt said that statin use was positively associated with lower risk for abnormal depression scores, anxiety scores, and hostility scores. There was no association with intermittent statin use, Dr. Blatt said.

The beneficial psychological effects of statin therapy were independent of the effect of statins on lipid profiles.

ACC 52nd Annual Scientific Session: Abstract 1040-82, presented March 30, 2003; Poster 1181-122, presented April 1, 2003.

Reviewed by Gary D. Vogin, MD

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