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Yang Q, Yang Z, Zeng B, Jia J, Sun F. Association of statin use with risk of depression and anxiety: A prospective large cohort study. Gen Hosp Psychiatry 2024; 90:108-115. [PMID: 39106577 DOI: 10.1016/j.genhosppsych.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/28/2024] [Accepted: 07/28/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVES To examine associations between regular statin use and the incidence of depression and anxiety. METHODS This cohort was based on UK Biobank participants without depression/anxiety recruited between 2006 and 2010. The self-reported regular statin use was collected at baseline. Depression and anxiety outcomes were assessed by diagnostic interviews (international classification of diseases codes) and nondiagnostic scales (mental well-being questionnaires). Cox proportional hazards models adjusted for a wide range of confounders were used to estimate associations of statins with incident depression/anxiety. RESULTS Among 363,551 eligible participants, 55,838 reported regular statin use. During a 13-year follow-up, 14,765 cases of depression and 15,494 cases of anxiety were identified. Compared with non-statin users, statin use was associated with reduced risk of depression (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.81, 0.94) and anxiety (HR: 0.90, 95% CI: 0.84, 0.97). Effects of statins on depression were consistent in sensitivity analyses and may be less influenced by unmeasured confounders. However, results of online survey data showed that statin use might not be associated with incident anxiety (HR: 0.96, 95% CI: 0.85, 1.09). CONCLUSION Regular statin use was associated with a lower risk of depression. No clear associations between statin use and anxiety were found.
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Affiliation(s)
- Qingqing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
| | - Zhirong Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Baoqi Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Central laboratory, Peking University Binhai Hospital, Tianjin, China.
| | - Jinzhu Jia
- Department of Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Statistical Science, Peking University, Beijing, China.
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China; Xinjiang Medical University, Xinjiang Uygur Autonomous Region, China.
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Zafari Z, Park JE, Shah CH, dosReis S, Gorman EF, Hua W, Ma Y, Tian F. The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies. Am J Epidemiol 2024; 193:426-453. [PMID: 37851862 DOI: 10.1093/aje/kwad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
Uses of real-world data in drug safety and effectiveness studies are often challenged by various sources of bias. We undertook a systematic search of the published literature through September 2020 to evaluate the state of use and utility of negative controls to address bias in pharmacoepidemiologic studies. Two reviewers independently evaluated study eligibility and abstracted data. Our search identified 184 eligible studies for inclusion. Cohort studies (115, 63%) and administrative data (114, 62%) were, respectively, the most common study design and data type used. Most studies used negative control outcomes (91, 50%), and for most studies the target source of bias was unmeasured confounding (93, 51%). We identified 4 utility domains of negative controls: 1) bias detection (149, 81%), 2) bias correction (16, 9%), 3) P-value calibration (8, 4%), and 4) performance assessment of different methods used in drug safety studies (31, 17%). The most popular methodologies used were the 95% confidence interval and P-value calibration. In addition, we identified 2 reference sets with structured steps to check the causality assumption of the negative control. While negative controls are powerful tools in bias detection, we found many studies lacked checking the underlying assumptions. This article is part of a Special Collection on Pharmacoepidemiology.
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Hanidu I, Johnson R, Ahorukomeye P, Ahn NU. Association Between Hypercholesterolemia and Lumbar Degenerative Back Pain: A Medicare Expenditure Panel Survey (MEPS) Study. Cureus 2023; 15:e47930. [PMID: 38034239 PMCID: PMC10684830 DOI: 10.7759/cureus.47930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Hypercholesterolemia is known to be a major contributor to the morbidity associated with cardiovascular disease and has been hypothesized to result in degenerative changes to the spine through atherosclerosis of segmental lumbar vessels. The purpose of this study is to determine the relationship between hypercholesterolemia and degenerative lumbar spine conditions in a U.S. cohort. Methods A total of 30,461 participated in the 2018 Medicare Expenditure Panel Survey (MEPS). Of those, 1,063 subjects responded to whether a diagnosis of lumbar disorders with low back pain was present. Odds ratios (OR) were calculated, and logistic regression analyses were adjusted for demographic, education, occupation, cardiovascular and mental health conditions. Results Of the 1,063 respondents, 455 (43%) reported back pain. Mean age of the respondents was 62.7±16.1. Men and women reported back pain at similar rates (43% vs 45%, p=0.664). Age, race, education level and occupation were similar between those with and without back pain (p>0.05). Those with a diagnosis of depression had higher odds of having back pain (p<0.05). Prevalence of back pain in subjects who responded to the back pain diagnosis item on the survey was 42.6%. On univariate analysis, diagnosis of total cholesterol levels was significantly higher in those with a diagnosis of back pain (OR 1.36, 95% CI [1.20-1.54], p<.0001). Multivariable analysis showed that hypercholesterolemia was independently associated with back pain (adjusted OR 1.32, 95% CI [1.04-1.68], p=0.021) after controlling for covariates. Conclusions In this study, subjects with hypercholesterolemia were 34% more likely to have back pain after controlling for confounders which presents as a recent discovery amongst U.S. populations. Further studies should be performed to investigate the management of hypercholesterolemia in the development and progression of degenerative lumbar back pain.
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Affiliation(s)
- Idris Hanidu
- Orthopedic Surgery, University of Illinois at Chicago, Chicago, USA
| | - Ryan Johnson
- Orthopedic Surgery, Meharry Medical College School of Medicine, Atlanta, USA
| | - Peter Ahorukomeye
- Orthopedic Surgery, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Nicholas U Ahn
- Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
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van Gemert Y, Blom AB, Di Ceglie I, Walgreen B, Helsen M, Sloetjes A, Vogl T, Roth J, Kruisbergen NNL, Pieterman EJ, Princen HMG, van der Kraan PM, van Lent PLEM, van den Bosch MHJ. Intensive cholesterol-lowering treatment reduces synovial inflammation during early collagenase-induced osteoarthritis, but not pathology at end-stage disease in female dyslipidemic E3L.CETP mice. Osteoarthritis Cartilage 2023:S1063-4584(23)00703-3. [PMID: 36898656 DOI: 10.1016/j.joca.2023.01.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION The association between metabolic syndrome (MetS) and osteoarthritis (OA) development has become increasingly recognized. In this context, the exact role of cholesterol and cholesterol-lowering therapies in OA development has remained elusive. Recently, we did not observe beneficial effects of intensive cholesterol-lowering treatments on spontaneous OA development in E3L.CETP mice. We postulated that in the presence of local inflammation caused by a joint lesion, cholesterol-lowering therapies may ameliorate OA pathology. MATERIALS AND METHODS Female ApoE3∗Leiden.CETP mice were fed a cholesterol-supplemented Western type diet. After 3 weeks, half of the mice received intensive cholesterol-lowering treatment consisting of atorvastatin and the anti-PCSK9 antibody alirocumab. Three weeks after the start of the treatment, OA was induced via intra-articular injections of collagenase. Serum levels of cholesterol and triglycerides were monitored throughout the study. Knee joints were analyzed for synovial inflammation, cartilage degeneration, subchondral bone sclerosis and ectopic bone formation using histology. Inflammatory cytokines were determined in serum and synovial washouts. RESULTS Cholesterol-lowering treatment strongly reduced serum cholesterol and triglyceride levels. Mice receiving cholesterol-lowering treatment showed a significant reduction in synovial inflammation (P = 0.008, WTD: 95% CI: 1.4- 2.3; WTD + AA: 95% CI: 0.8- 1.5) and synovial lining thickness (WTD: 95% CI: 3.0-4.6, WTD + AA: 95% CI: 2.1-3.2) during early-stage collagenase-induced OA. Serum levels of S100A8/A9, MCP-1 and KC were significantly reduced after cholesterol-lowering treatment (P = 0.0005, 95% CI: -46.0 to -12.0; P = 2.8 × 10-10, 95% CI: -398.3 to -152.1; P = 2.1 × 10-9, -66.8 to -30.4, respectively). However, this reduction did not reduce OA pathology, determined by ectopic bone formation, subchondral bone sclerosis and cartilage damage at end-stage disease. CONCLUSION This study shows that intensive cholesterol-lowering treatment reduces joint inflammation after induction of collagenase-induced OA, but this did not reduce end stage pathology in female mice.
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Affiliation(s)
- Y van Gemert
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A B Blom
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I Di Ceglie
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B Walgreen
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M Helsen
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Sloetjes
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - T Vogl
- Institute of Immunology, University of Münster, Germany
| | - J Roth
- Institute of Immunology, University of Münster, Germany
| | - N N L Kruisbergen
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E J Pieterman
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - H M G Princen
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - P M van der Kraan
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P L E M van Lent
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M H J van den Bosch
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Ahorukomeye P, Mahajan A, Du JY, Yu CC, Bhandutia AK, Ahn NU. Association Between Hypercholesterolemia and Neck Pain in a Cross-sectional Population-based Study. Spine (Phila Pa 1976) 2023; 48:137-142. [PMID: 36122297 DOI: 10.1097/brs.0000000000004485] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional analysis. SUMMARY OF BACKGROUND DATA Degenerative changes are a major contributor to chronic neck pain. According to the vascular hypothesis of disk disease, atherosclerosis of the segmental arteries contributes to ischemia of the lumbar disks and resulting degenerative changes. Prior studies have demonstrated an association between atherosclerotic risk factors and lumbar degenerative disease. Similarly, atherosclerosis may contribute to cervical disk degeneration. Cardiovascular disease is associated with the development of atherosclerosis, particularly in small vessels to the cervical spine. Hypercholesterolemia is a major contributor to the morbidity associated with cardiovascular disease. This study aims to examine the relationship between hypercholesterolemia and neck pain. MATERIALS AND METHODS Analysis was focused on the respondents to neck pain items of the standardized questionnaire. Odds ratios were calculated, and logistic regression analyses adjusted for demographic, education, and mental health conditions. RESULTS There were 30,461 participants in the 2018 Medicare Expenditure Panel Survey (MEPS) survey. Of those, 1049 (3.4%) subjects responded to presence of a diagnosis of cervical disorders with neck pain. Mean age of respondents was 62.6±16.1. Overall prevalence of neck pain was 21.1%. Prevalence of neck pain was similar by age, sex, education level, and occupation ( P >0.05 for each). Neck pain was more prevalent in white race and lower total family income ( P <0.05). Current everyday smokers also had higher prevalence of neck pain ( P <0.05). Logistic regression analysis revealed a higher prevalence of neck pain in those with hypercholesterolemia after controlling for relevant covariates (adjusted odds ratio=1.54, 95% CI: 1.08-2.22, P =0.018). CONCLUSIONS Subjects with hypercholesterolemia were 54% more likely to have neck pain after controlling for confounders. This suggests that hypercholesterolemia has a role to play in degeneration of the cervical spine. Therefore, prevention and proper management of high cholesterol may curtail the development and progression of degenerative cervical disk disease and thus, neck pain.
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Affiliation(s)
- Peter Ahorukomeye
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve School of Medicine, Cleveland, OH
| | | | - Jerry Y Du
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | | | - Nicholas U Ahn
- University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve School of Medicine, Cleveland, OH
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Ye X, Blais JE, Ng VWS, Castle D, Hayes JF, Wei Y, Kang W, Gao L, Yan VKC, Wong ICK, Chan EW. Association between statins and the risk of suicide attempt, depression, anxiety, and seizure: A population-based, self-controlled case series study. J Affect Disord 2023; 320:421-427. [PMID: 36206879 DOI: 10.1016/j.jad.2022.09.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Risk of suicide attempt, depression, anxiety and seizure and the association with statins is an ongoing debate. We aim to investigate the association between statins and the above neuropsychological outcomes, in specific pre- and post-exposure time windows. METHODS We identified patients aged 40-75 years old who were dispensed a statin between January 1, 2003 and December 31, 2012 from the Hong Kong Clinical Data Analysis & Reporting System (CDARS), an electronic medical records database. Patients with new onset of suicide attempt, depression, anxiety and seizure were derived from the original dataset separately, in a self-controlled case series study design. A non-parametric spline-based self-controlled case series model was built to measure continuous changes of risk. RESULTS We identified 396,614 statin users. The risk of each outcome was elevated prior to statin initiation with incidence rate ratios of 1.38 (95 % CI, 1.09-1.74) for suicide attempt, 1.29 (95 % CI, 1.15-1.45) for depression, 1.35 (95 % CI, 1.19-1.53) for anxiety, and 1.45 (95 % CI, 1.21-1.73) for seizure. The incidence rate ratios remained elevated after the initiation of statins during the first 90 and 91-365 days after statin prescription and decreased to the baseline level after 1 year of continuous prescription. LIMITATIONS CDARS includes prescription data but not adherence data, which could lead to misclassification of exposure periods. CONCLUSIONS Our study does not support a direct association between statin use and suicide attempt, depression, anxiety and seizure, whose risks could be explained by cardiovascular events, for which statins were prescribed.
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Affiliation(s)
- Xuxiao Ye
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Joseph E Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China; School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Vanessa W S Ng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - David Castle
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, United Kingdom
| | - Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wei Kang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Vincent K C Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health, Hong Kong, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health, Hong Kong, China; Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China.
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Zhang Z, Deng C, Ma X, Wu Q, Zhou F, Liu X. The association between statin use and osteoarthritis-related outcomes: An updated systematic review and meta-analysis. Front Pharmacol 2022; 13:1003370. [PMID: 36506528 PMCID: PMC9729269 DOI: 10.3389/fphar.2022.1003370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: Findings among studies evaluating the effect of statin use and OA development in a 2020 meta-analysis of data from 11 observational studies of statin use and osteoarthritis (OA) revealed controversial results. We aimed to determine the associations between statin use and OA-related outcomes in an updated meta-analysis. Methods: The protocol was registered with PROSPERO (CRD42020163983). A systematic literature retrieval was performed in the online databases, including PubMed, Cochrane Library, Embase, Web of Science, and Scopus, from inception to 1 June 2022, for clinical studies that compared the effects of statin users vs. nonusers on OA-related outcomes risks. Systematic reviews and meta-analyses were performed to estimate the correlations between statin use and OA-related outcomes. Tendency analysis was also used to estimate dose-response effects. The risk of bias was evaluated with the Newcastle-Ottawa scale. Results: We included 23 studies involving more than 6,000,000 participants. Statin use was associated with increased OA risk (OR 1.099 [95%CI 1.002-1.206, p = 0.045]). Higher statin doses had higher OA risk (simvastatin equivalent daily of >40 mg). OA and related surgery risks were significantly reduced in statin users using antihypertensive drugs (AHDs). No significant differences were seen in other outcomes. Conclusion: This meta-analysis inferred that statin use might be associated with increased OA development, especially at higher doses. The present study highlights the importance of recognizing potential OA risk in the population with long-term and/or high-dose statin use, especially in older populations. In addition, AHDs are associated with lower OA risk and fewer surgeries in hypertensive statin users. Due to limitations of heterogeneity and confounders, more rigorous studies are needed to define the correlations between statin use and OA-related outcomes.
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Affiliation(s)
- Zhan Zhang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunbo Deng
- Department of Orthopedics, Central Hospital of Shenyang Medical College, Shenyang, China
| | - Xun Ma
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qijun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueyong Liu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
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8
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Lee SY, Wong PF, Jamal J, Roebuck MM. Naturally-derived endoplasmic reticulum stress inhibitors for osteoarthritis? Eur J Pharmacol 2022; 922:174903. [DOI: 10.1016/j.ejphar.2022.174903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 01/15/2023]
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Heidari B, Babaei M, Yosefghahri B. Prevention of Osteoarthritis Progression by Statins, Targeting Metabolic and Inflammatory Aspects: A Review. Mediterr J Rheumatol 2021; 32:227-236. [PMID: 34964026 PMCID: PMC8693300 DOI: 10.31138/mjr.32.3.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 01/17/2023] Open
Abstract
Background and purpose: Several traditional risk factors of atherosclerosis such as age, obesity, and altered lipid metabolism are shared with osteoarthritis (OA). Metabolic abnormalities and atheromatous vascular disease are linked with systemic inflammation and progression of OA. Hence, treatment of OA with statins is expected to improve metabolic abnormalities and prevent OA progression. Many studies which have addressed this issue found inconsistent results. This review aims to elucidate the effect of statins in OA by summarizing the existing data. Methods: Potential studies in English language published in Medline/PubMed, Scopus and Google Scholar since 2000 were searched by using keywords such as osteoarthritis, statins, progression, treatment, prevalence, synovitis, pain. Fourteen papers were found to be relevant and were summarised. Results: Data regarding symptomatic effect of statins in OA are scarce and the results varied from no effect to a small improvement or even increased risk of pain in knee OA. However, most studies on the incidence and progression of OA found a significant decreased risk of incident OA, as well as reduced risk of radiographic progression in statin users vs. non-users. Factors such as patient adherence, duration of treatment, and higher cumulative statin doses were associated with greater efficacy. Conclusion: Existing data indicate a preventing effect of statin therapy on OA progression. However, unless a formal meta-analysis with weight analysis is made, a conclusion cannot be drawn.
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Affiliation(s)
- Behzad Heidari
- Mobility Impairment Research Centre, Babol University of Medical Sciences, Babol, Iran
| | - Mansour Babaei
- Mobility Impairment Research Centre, Babol University of Medical Sciences, Babol, Iran.,Department of Medicine, Division of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Behnaz Yosefghahri
- Department of Medicine, Division of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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Papathanasiou I, Anastasopoulou L, Tsezou A. Cholesterol metabolism related genes in osteoarthritis. Bone 2021; 152:116076. [PMID: 34174501 DOI: 10.1016/j.bone.2021.116076] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
Cholesterol homeostasis plays a significant role in skeletal development and the dysregulation of cholesterol-related mechanism has been shown to be involved in the development of cartilage diseases including osteoarthritis (OA). Epidemiological studies have shown an association between elevated serum cholesterol levels and OA. Furthermore, abnormal lipid accumulation in chondrocytes as a result of abnormal regulation of cholesterol homeostasis has been demonstrated to be involved in the development of OA. Although, many in vivo and in vitro studies support the connection between cholesterol and cartilage degradation, the mechanisms underlying the complex interactions between lipid metabolism, especially HDL cholesterol metabolism, and OA remain unclear. The current review aims to address this problem and focuses on key molecular players of the HDL metabolism pathway and their role in ΟΑ pathogenesis. Understanding the complexity of biological processes implicated in OA pathogenesis, such as cholesterol metabolism, may lead to new targets for drug therapy of OA patients.
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Affiliation(s)
- Ioanna Papathanasiou
- Department of Biology, University of Thessaly, Faculty of Medicine, Larisa, Greece; Department of Cytogenetics and Molecular Genetics, University of Thessaly, Faculty of Medicine, Larisa, Greece
| | - Lydia Anastasopoulou
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, 35392 Giessen, Germany
| | - Aspasia Tsezou
- Department of Biology, University of Thessaly, Faculty of Medicine, Larisa, Greece; Department of Cytogenetics and Molecular Genetics, University of Thessaly, Faculty of Medicine, Larisa, Greece.
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11
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van Gemert Y, Kozijn AE, Pouwer MG, Kruisbergen NNL, van den Bosch MHJ, Blom AB, Pieterman EJ, Weinans H, Stoop R, Princen HMG, van Lent PLEM. Novel high-intensive cholesterol-lowering therapies do not ameliorate knee OA development in humanized dyslipidemic mice. Osteoarthritis Cartilage 2021; 29:1314-1323. [PMID: 33722697 DOI: 10.1016/j.joca.2021.02.570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/03/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High systemic cholesterol levels have been associated with osteoarthritis (OA) development. Therefore, cholesterol lowering by statins has been suggested as a potential treatment for OA. We investigated whether therapeutic high-intensive cholesterol-lowering attenuated OA development in dyslipidemic APOE∗3Leiden.CETP mice. METHODS Female mice (n = 13-16 per group) were fed a Western-type diet (WTD) for 38 weeks. After 13 weeks, mice were divided into a baseline group and five groups receiving WTD alone or with treatment: atorvastatin alone, combined with PCSK9 inhibitor alirocumab and/or ANGPTL3 inhibitor evinacumab. Knee joints were analysed for cartilage degradation, synovial inflammation and ectopic bone formation using histology. Aggrecanase activity in articular cartilage and synovial S100A8 expression were determined as markers of cartilage degradation/regeneration and inflammation. RESULTS Cartilage degradation and active repair were significantly increased in WTD-fed mice, but cholesterol-lowering strategies did not ameliorate cartilage destruction. This was supported by comparable aggrecanase activity and S100A8 expression in all treatment groups. Ectopic bone formation was comparable between groups and independent of cholesterol levels. CONCLUSIONS Intensive therapeutic cholesterol lowering per se did not attenuate progression of cartilage degradation in dyslipidemic APOE∗3Leiden.CETP mice, with minor joint inflammation. We propose that inflammation is a key feature in the disease and therapeutic cholesterol-lowering strategies may still be promising for OA patients presenting both dyslipidemia and inflammation.
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Affiliation(s)
- Y van Gemert
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A E Kozijn
- Metabolic Health Research, TNO, Leiden, the Netherlands; Department of Orthopaedics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M G Pouwer
- Metabolic Health Research, TNO, Leiden, the Netherlands; Department of Cardiology, Leiden UMC, Leiden, the Netherlands
| | - N N L Kruisbergen
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M H J van den Bosch
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A B Blom
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E J Pieterman
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - H Weinans
- Department of Orthopaedics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Stoop
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - H M G Princen
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - P L E M van Lent
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands.
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12
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Nukala S, Puvvada SR, Luvsannyam E, Patel D, Hamid P. Hyperlipidemia and Statin Use on the Progression of Osteoarthritis: A Systematic Review. Cureus 2021; 13:e15999. [PMID: 34336490 PMCID: PMC8318615 DOI: 10.7759/cureus.15999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Osteoarthritis (OA) is progressive wear and tear disease that affects multiple joints, including knees, hips, and spine. OA causes structural damage to joints. Although hypertension, type II diabetes, and hyperlipidemia have a silent effect, for the most part, the addition of osteoarthritis has a limiting and debilitating impact on patients. Common symptoms of OA include joint pain, joint swelling, limitations in range of motion that is impacting one’s quality of life. The question being investigated in this systematic review is whether hyperlipidemia or the use of statin has any effect on osteoarthritis and progression of osteoarthritis. This systematic review of 13 articles was done to explore if there is an effect of hyperlipidemia and statin use on the progression of osteoarthritis. This study included 6,974,538 total participants. Eight studies out of the 13 investigated the effect of statin use. Out of the 13 articles, five studies investigated the impact of lipid levels on OA. The total participants cannot be divided into statin users and non-users because some studies did not divide the participants into two groups. Studies that investigated the effect of lipid levels on OA were studied based on age. Some included only women in their study, and one study was solely conducted in the military population. Therefore, these studies cannot be divided based on age. Further research is needed to significantly conclude either the positive or negative correlation of hyperlipidemia and statin use on osteoarthritis and its progression.
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Affiliation(s)
- Swetha Nukala
- Department of Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Suvarna Rekha Puvvada
- Department of Research, California Instititute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Enkhmaa Luvsannyam
- Department of Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhara Patel
- Department of Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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13
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Sarmanova A, Doherty M, Kuo C, Wei J, Abhishek A, Mallen C, Zeng C, Wang Y, Lei G, Zhang W. Statin use and risk of joint replacement due to osteoarthritis and rheumatoid arthritis: a propensity-score matched longitudinal cohort study. Rheumatology (Oxford) 2021; 59:2898-2907. [PMID: 32097491 DOI: 10.1093/rheumatology/keaa044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/20/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Statins are reported to have a potential benefit on progression of OA and on disease activity in RA, but existing evidence is conflicting. Our objective was to examine whether statins associate with reduction in the risk for joint replacement due to OA and RA. METHODS This was a propensity score-matched cohort study. Electronic health records from the UK Clinical Practice Research Datalink were used. We selected people prescribed statins and people never prescribed statins. Each statin user was matched to a non-user by age, gender, practice and propensity score for statin prescription. The main outcome measures were knee or hip joint replacement overall, and specifically because of OA or RA. The association between statins and risk of joint replacement was assessed using Cox proportional hazard regression. Statin exposure was categorized according to the potency of reducing low-density lipoprotein as low (21-28%), medium (32-38%) or high (42-55%) intensity. RESULTS A total of 178 467 statin users were matched with 178 467 non-users by age, gender, practice and propensity score. Overall, statin was not associated with reduced risk of knee or hip replacement (hazard ratio 0.99, 95% CI: 0.97, 1.03), unless prescribed at high strength (0.86, 0.75-0.98). The reduced risk was only observed for joint replacement due to RA (0.77, 0.63-0.94) but not OA (0.97, 0.94-1.01). CONCLUSION Statins at high intensity may reduce the risk of hip or knee replacement. This effect may be RA specific. Further studies to investigate mechanisms of risk reduction and the impact in people with RA are warranted.
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Affiliation(s)
- Aliya Sarmanova
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,MRC Integrative Epidemiology Unit, Bristol Medical School (PHS), University of Bristol, Bristol, UK
| | - Michael Doherty
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Changfu Kuo
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, MA, USA.,Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Abhishek Abhishek
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Chao Zeng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, MA, USA.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weiya Zhang
- Academic Rheumatology Department, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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14
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Wang J, Dong J, Yang J, Wang Y, Liu J. Association between statin use and incidence or progression of osteoarthritis: meta-analysis of observational studies. Osteoarthritis Cartilage 2020; 28:1170-1179. [PMID: 32360737 DOI: 10.1016/j.joca.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/26/2020] [Accepted: 04/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the study was to determine whether statin use could reduce the risk of the incidence or progression of osteoarthritis (OA). METHODS The PubMed, Embase, and Cochrane databases were systematically searched for observational studies on the association between statin use and OA. ORs and 95% CIs were directly retrieved or calculated. The Newcastle-Ottawa quality assessment scale was used for study quality assessment. Subgroup analysis, sensitivity analysis, and publication bias were conducted using Stata software. RESULTS A total of 11 studies (679807 participants) were identified from the systematic literature search. No significant association between statin use and incidence (OR = 1.010; 95% CI: 0.968 to 1.055; P = 0.638) or progression (OR = 1.076; 95% CI: 0.824 to 1.405; P = 0.589) of OA was found in our meta-analysis. The meta-analysis according to the symptomatic or radiological OA also found no significant association between statin use and OA. The subgroup analysis showed that atorvastatin (OR = 0.953; 95% CI: 0.911 to 0.998; P = 0.041) and rosuvastatin (OR = 1.180; 95% CI: 1.122 to 1.241; P < 0.0001) had opposite effects on OA. The results of the analysis according to the joint site, interval, and statin dose were all not significant. CONCLUSIONS Statin use may not be associated with a lower risk of incidence and progression of OA, regardless of joint site. The opposite effects of atorvastatin and rosuvastatin were detected in OA.
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Affiliation(s)
- J Wang
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China.
| | - J Dong
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - J Yang
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - Y Wang
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
| | - J Liu
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin, China
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15
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Abstract
Osteoarthritis (OA) is one of the most debilitating diseases and is associated with a high personal and socioeconomic burden. So far, there is no therapy available that effectively arrests structural deterioration of cartilage and bone or is able to successfully reverse any of the existing structural defects. Efforts to identify more tailored treatment options led to the development of strategies that enabled the classification of patient subgroups from the pool of heterogeneous phenotypes that display distinct common characteristics. To this end, the classification differentiates the structural endotypes into cartilage and bone subtypes, which are predominantly driven by structure-related degenerative events. In addition, further classifications have highlighted individuals with an increased inflammatory contribution (inflammatory phenotype) and pain-driven phenotypes as well as senescence and metabolic syndrome phenotypes. Most probably, it will not be possible to classify individuals by a single definite subtype, but it might help to identify groups of patients with a predominant pathology that would more likely benefit from a specific drug or cell-based therapy. Current clinical trials addressed mainly regeneration/repair of cartilage and bone defects or targeted pro-inflammatory mediators by intra-articular injections of drugs and antibodies. Pain was treated mostly by antagonizing nerve growth factor (NGF) activity and its receptor tropomyosin-related kinase A (TrkA). Therapies targeting metabolic disorders such as diabetes mellitus and senescence/aging-related pathologies are not specifically addressing OA. However, none of these therapies has been proven to modify disease progression significantly or successfully prevent final joint replacement in the advanced disease stage. Within this review, we discuss the recent advances in phenotype-specific treatment options and evaluate their applicability for use in personalized OA therapy.
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Affiliation(s)
- Susanne Grässel
- Department of Orthopedic Surgery, Exp. Orthopedics, ZMB/Biopark 1, Am Biopark 9, University of Regensburg, Regensburg, 93053, Germany
| | - Dominique Muschter
- Department of Orthopedic Surgery, Exp. Orthopedics, ZMB/Biopark 1, Am Biopark 9, University of Regensburg, Regensburg, 93053, Germany
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