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Association Between Statin Use and Depressive Symptoms in a Large Community-Dwelling Older Population Living in Australia and the USA: A Cross-Sectional Study

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Abstract

Background

Statin use has been frequently associated with depressive symptoms in an older population. However, the nature of this association is uncertain in the literature. In this study, we aimed to investigate the association of statin intake and the prevalence of depressive symptoms in healthy community-dwelling older adults living in Australia and the USA.

Methods

We analysed baseline data from 19,114 participants, over 70 years of age (over 65 years of age, if from an ethnic minority). The association of self-reported statin use and prevalence of depressive symptoms, as measured by a validated depression scale [Center for Epidemiological Studies Depression Scale (CES-D 10)], was determined using logistic regression models. Multivariable logistic models were implemented to account for important demographics and other lifestyle and socioeconomic factors, such as sex, age, living status, education and smoking history.

Results

A total of 5987 individuals were statin users. Of those, 633 (10.6%) had depressive symptoms (CES-D 10 cut-off ≥ 8), compared with 1246 (9.5%) of the non-statin users. In the unadjusted model, statin use was associated with an increase in prevalence of depressive symptoms (odds ratio 1.13, confidence interval 1.02–1.25, p = 0.02). However, after adjusting for important demographic and socioeconomic factors, the use of statins was not significantly associated with depressive symptoms (odds ratio 1.09, confidence interval 0.98–1.20, p = 0.11). In secondary analyses, only simvastatin was marginally associated with an increased prevalence of depressive symptoms. Statins were associated with a decreased prevalence of depressive symptoms in individuals with severe obesity (body mass index > 35 kg/m2) and an increased prevalence in participants between 75 and 84 years of age.

Conclusion

This study in a large community-dwelling older population did not show any association of statins with late-life depressive symptoms, after accounting for important socioeconomic and demographic factors. Confounding by indication is an important issue to be addressed in future pharmacoepidemiologic studies of statins.

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Acknowledgements

The authors acknowledge the efforts of research personnel and the long-term involvement of participants of the ASPREE study.

Author information

Authors and Affiliations

  1. IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia

    Bruno Agustini, Mohammadreza Mohebbi & Michael Berk

  2. Biostatistics Unit, Deakin University, Geelong, VIC, Australia

    Mohammadreza Mohebbi

  3. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Robyn L. Woods, John J. McNeil, Christopher M. Reid, Andrew Tonkin & Jessica E. Lockery

  4. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia

    Mark R. Nelson

  5. Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA

    Raj C. Shah

  6. Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA

    Anne M. Murray

  7. Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IO, USA

    Michael E. Ernst

  8. Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IO, USA

    Michael E. Ernst

  9. School of Public Health, Curtin University, Perth, WA, Australia

    Christopher M. Reid

  10. Orygen, National Centre of Excellence in Youth Health, Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia

    Michael Berk

Authors
  1. Bruno Agustini
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  2. Mohammadreza Mohebbi
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  8. Michael E. Ernst
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  12. Michael Berk
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Consortia

the ASPREE Investigator Group

Contributions

JJM, RLW, MRN, RCS, CMR and JEL contributed to the design of the original ASPREE randomised controlled trial. MB, RLW, MRN, RCS, CMR, AT, CB, JEL, MM and JJM contributed to the design of the ASPREE-D sub-study. All authors actively participated in designing the current study. BA and MM performed the data analysis. BA drafted the manuscript that has been read, edited and approved by all co-authors.

Corresponding author

Correspondence to Bruno Agustini.

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Funding

The study is supported by the National Institute on Aging and the National Cancer Institute at the National Institutes of Health (Grant No. U01AG029824), the National Health and Medical Research Council of Australia (Grant Nos. 334047, 1127060), Monash University (Australia) and the Victorian Cancer Agency (Australia). Michael Berk is supported by a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship (APP1059660 and APP1156072) and Christopher M. Reid is supported by a NHMRC Senior Research Fellowship (APP1045862).

Conflict of interest

Bruno Agustini, Mohammadreza Mohebbi, Robyn L. Woods, John J. McNeil, Mark R. Nelson, Raj C. Shah, Anne M. Murray, Michael E. Ernst, Christopher M. Reid, Andrew Tonkin, Jessica E. Lockery and Michael Berk have not conflicts of interest that are directly relevant to the content of this article.

Ethics approval

The ASPREE study was conducted in accordance with the Declaration of Helsinki 1964 as revised in 2008, the NHMRC Guidelines on Human Experimentation, the federal patient privacy (HIPAA) law and the International Conference of Harmonisation Guidelines for Good Clinical Practice. ASPREE also follows the Code of Federal Regulations as it relates to areas of clinical research.

Additional information

ASPREE Investigator Group listed on www.aspree.org.

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Agustini, B., Mohebbi, M., Woods, R.L. et al. Association Between Statin Use and Depressive Symptoms in a Large Community-Dwelling Older Population Living in Australia and the USA: A Cross-Sectional Study. CNS Drugs 33, 685–694 (2019). https://doi.org/10.1007/s40263-019-00633-3

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  • DOI: https://doi.org/10.1007/s40263-019-00633-3

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