The potential behavioral and economic impacts of widespread HMG-CoA reductase inhibitor (statin) use

Paradoxical effect of statin medication on depressive disorder in first-ever ischemic stroke patients: possible antidepressant-like effect prestroke and the opposite in continuous medication poststroke

Poststroke depression (PSD) is the most frequent complication after stroke. Statin is a widely used prophylactic for stroke. However, some researchers reported that poststroke statin may lead to a depressive change in stroke patients. We aimed to study the effect of different statin medication timing especially prestroke timing on PSD to adopt appropriate intervention around stroke. Patients with first-ever ischemic stroke were consecutively observed from January 2012 to June 2017. They were grouped by different initiation time of statin treatment. The follow-up endpoints were set to: (1) diagnosis of PSD within 1-year and (2) censor data. Cox regression model adjusted for confounding factors was performed. A total of 1571 patients were included in the analyses, among which 210 (13.4%) were comorbided with PSD, and the median time of the course was 30 (14-98) days. The patients who received both pre- and poststroke statin treatment had 1.99 times (P = 0.037) the hazard faced by patients who did not receive that medication. In contrast, sole statin pretreatment may have the tendency to reduce the risk of PSD. Our findings provide the primary results for the prestroke statin medication. The initiation timing of continuous regular statin treatment ahead of ischemic stroke could have a correlation with a higher risk of PSD.

Low cholesterol, impulsivity and violence revisited

PURPOSE OF REVIEW

To summarize the recent findings on the association of cholesterol levels with impulsivity and violence.

RECENT FINDINGS

Several authors have recently highlighted the importance of confounding factors that mask the association between cholesterol and impulsivity or violent behaviour. In particular, demographic factors and presence of psychiatric disorders can play a role in the discrepancies present in literature. Men seem to be more sensitive to low cholesterol levels as the association between low cholesterol levels and aggression is found mostly in men. Cholesterol may play a role as a moderator of the serotonergic function and interact with associations between relevant gene variants and impulsivity. Lowering cholesterol levels with statins brings about several changes in the serotonergic system, nerve cell membrane microviscosity and behaviour, and needs to be done with precaution in susceptible individuals. Cholesterol levels could serve as a biological risk marker for violence and suicidal tendencies in psychiatric patients with depression and schizophrenia.

SUMMARY

Future studies should consider the potential nonlinearity in the association of cholesterol levels with impulsivity, and dependence of the association on gender, psychiatric condition, and environmental factors.