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Postolache TT, Medoff DR, Brown CH, Fang LJ, Upadhyaya SK, Lowry CA, Miller M, Kreyenbuhl JA. Lipophilic vs. hydrophilic statins and psychiatric hospitalizations and emergency room visits in US Veterans with schizophrenia and bipolar disorder. Pteridines 2021; 32:48-69. [PMID: 34887622 PMCID: PMC8654264 DOI: 10.1515/pteridines-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective – Psychiatric hospitalizations and emergency department (ED) visits are costly, stigmatizing, and often ineffective. Given the immune and kynurenine activation in bipolar disorder (BD) and schizophrenia, as well as the immune-modulatory effects of statins, we aimed to compare the relative risk (RRs) of psychiatric hospitalizations and ED visits between individuals prescribed lipophilic vs. hydrophilic statins vs. no statins. We hypothesized (a) reduced rates of hospitalization and ER utilization with statins versus no statins and (b) differences in outcomes between statins, as lipophilia increases the capability to penetrate the blood–brain barrier with potentially beneficial neuroimmune, antioxidant, neuroprotective, neurotrophic, and endothelial stabilizing effects, and, in contrast, potentially detrimental decreases in brain cholesterol concentrations leading to serotoninergic dysfunction, changes in membrane lipid composition, thus affecting ion channels and receptors. Methods – We used VA service utilization data from October 1, 2010 to September 30, 2015. The RRs for psychiatric hospitalization and ED visits, were estimated using robust Poisson regression analyses. The number of individuals analyzed was 683,129. Results – Individuals with schizophrenia and BD who received prescriptions for either lipophilic or hydrophilic statins had a lower RR of psychiatric hospitalization or ED visits relative to nonstatin controls. Hydrophilic statins were significantly associated with lower RRs of psychiatric hospitalization but not of ED visits, compared to lipophilic statins. Conclusion – The reduction in psychiatric hospitalizations in statin users (vs. nonusers) should be interpreted cautiously, as it carries a high risk of confounding by indication. While the lower RR of psychiatric hospitalizations in hydrophilic statins relative to the lipophilic statins is relatively bias free, the finding bears replication in a specifically designed study. If replicated, important clinical implications for personalizing statin treatment in patients with mental illness, investigating add-on statins for improved therapeutic control, and mechanistic exploration for identifying new treatment targets are natural next steps.
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Affiliation(s)
- Teodor T Postolache
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Baltimore, MD 21201, United States of America; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Aurora, CO 80045, United States of America; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), U.S. Department of Veterans Affairs, Denver, CO 80045, United States of America
| | - Deborah R Medoff
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Clayton H Brown
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Li Juan Fang
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Sanjaya K Upadhyaya
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Christopher A Lowry
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), U.S. Department of Veterans Affairs, Aurora, CO 80045, United States of America; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), U.S. Department of Veterans Affairs, Denver, CO 80045, United States of America; Department of Integrative Physiology, Center for Neuroscience, Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - Michael Miller
- Department of Medicine, VAMC Baltimore and University of Maryland School of Medicine, Baltimore, Maryland 21201, United States of America
| | - Julie A Kreyenbuhl
- VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD 21201, United States of America; Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
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