In asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome, patients who took statins had a lower risk for anxiety and depression compared with those not taking statins, regardless of demographic or clinical characteristics or use of inhaled or oral corticosteroids (ICS and OCS, respectively), according to a report published in the Journal of Affective Disorders.
Inflammatory cytokines may play a prominent role in the pathogenesis of both asthma-COPD overlap syndrome and anxiety and depression, which have also been linked to one another. Despite their proposed anti-inflammatory activity, no studies have examined the effect of statin use on the occurrence of anxiety and depression in patients diagnosed with this overlap syndrome. Investigators sought to explore the existence and magnitude of this effect, with an eye toward its relationship to ICS/OCS intake.
A retrospective population-based study used 2000 to 2010 data from the Taiwanese National Health Insurance Research Database to enroll 9139 participants (61.6% men) with asthma-COPD overlap syndrome, divided into a treatment group of those taking statins (n=1252) and a control group of those not taking statins (n=7887), with groups matched for sex, age, index year, and comorbidities. Cox proportional regression analysis was performed to assess cumulative anxiety and depression incidence rates and to calculate adjusted hazard ratios (aHRs) and 95% CIs.
Statin users were significantly younger than nonstatin users (mean age, 63.5 vs 65.3 years; P <.001), with significantly more comorbidities (P <.001). Patients in the treatment group used steroids significantly more often than those in the control group (P <.001 for both ICS and OCS).
Following multivariable adjustment for demographics, comorbidities, and medication use, the statin treatment group demonstrated significantly lower incidences (log-rank P <.001 for both) and risks compared with the nonstatin control group for both anxiety (incidence rates, 11.3 vs 33.2 per 1000 person-years; aHR, 0.34; 95% CI, 0.28-0.42) and depression (incidence rates, 3.18 vs 8.61 per 1000 person-years; aHR, 0.36; 95% CI, 0.25-0.53). When ICS or OCS use was taken into account, patients who used statins and took either type of steroid had similar risk levels for anxiety (ICS: aHR, 0.43; 95% CI, 0.28-0.68; OCS: aHR, 0.36; 95% CI, 0.28-0.46) and depression (ICS: aHR, 0.32; 95% CI, 0.13-0.78; OCS: aHR, 0.37; 95% CI, 0.24-0.57).
Study strengths included recording of all medications at each visit, age and sex adjustment, use of steroid status as a time-variant covariate, robust data collection over multiple visits, and internal and external validation.
Study limitations included lack of information on prescribed daily doses, presence of time-dependent covariates, potential drug utilization misclassification, retrospective design that offered lower levels of evidence, and possible uncontrolled confounding factors.
“We conclude that the anti-inflammatory effect of statins may attenuate anxiety and depression in ACOS [asthma-COPD overlap syndrome] patients, even in the late stages of the disease,” the authors wrote. They recommended that future research involve larger randomized controlled trials and exploration of the role of cytokines in the pathogenesis of the various considered conditions.
Yeh J-J, Syue S-H, Lin C-L, Hsu CY, Shae Z, Kao C-H. Effects of statins on anxiety and depression in patients with asthma-chronic obstructive pulmonary disease overlap syndrome. J Affect Disord. 2019;253:277-284.