Do statins work similarly for patients with severe mental illness?

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Takeaway

  • Statin prescribing to patients with severe mental illness (SMI) was associated with similar level of benefit to the general population with observed reductions for total cholesterol of 1.2 mmol/L up to 2 y.
  • This suggests that medication adherence is sufficient for effective lipid modifications.

Why this matters

  • Compared with patients without SMI, those with SMI including schizophrenia and bipolar disorder are at a higher risk for cardiovascular disease.

Study design

  • Study included patients diagnosed with SMI (age, 40-84 y) who were exposed to 1 or more statin prescription during a 24-mo ‘baseline’ period.
  • Primary outcome was combined first myocardial infarction (MI) and stroke; secondary outcome included all-cause mortality and total cholesterol concentration.
  • Funding: NIHR.

Key results

  • 2944 statin users and 42,886 non-users were included.
  • After adjustment for covariates, statin prescribing was not associated with significant reduction in MI and stroke events (incident rate ratio [IRR], 0.89) or all-cause mortality (IRR, 0.89).
  • Statin prescribing was associated with statistically significant reductions in total cholesterol of 1.2 mmol/L up to 2 y (P<.001).
  • In statin users, the total cholesterol decreased from 6.3 mmol/L to 4.6 mmol/L, and from 5.4 mmol/L to 5.3 mmol/L in non-users.

Limitations

  • Missing data on total cholesterol at baseline.
  • Residual confounding.