Depression Risk Elevated in TBI Patients with High Cholesterol

Patients diagnosed with traumatic brain injury have an increased risk of depression if they have high lipid levels, particularly if their hyperlipidemia is not controlled with statins, according to research published in the Journal of Clinical Psychiatry.

“The finding of no difference in the risk of new-onset depression between TBI patients without hyperlipidemia and statin-treated TBI patients implies that statins may play a critical role in the development of new-onset depression,” wrote Hsiao-Yue Wee, MD, of Chi-Mei Medical Center in Taiwan, and his colleagues.

Using data from a national health insurance database from January 2001 to December 2008, the researchers followed 3792 patients diagnosed with TBI but with no history of depression. One third of these patients had hyperlipidemia at the start of the study, and each was matched by age and sex to two others without hyperlipidemia in the overall cohort.

During at least three years of follow-up, 4% of the TBI patients with hyperlipidemia and 2.3% of those without it developed depression. Among age groups 35-50 and 65-80, the TBI patients with pre-existing hyperlipidemia were more than twice as likely to develop depression during follow-up than those without hyperlipidemia. Further, compared to those without hyperlipidemia, depression occurred 1.86 times more in women and 1.63 times more in men with  hyperlipidemia.

After accounting for age, sex, income, statin use and the comorbidities of hypertension, cardiovascular disease or diabetes, TBI patients with hyperlipidemia were still 61% more likely to develop depression. Another independent risk factor was cardiovascular disease, which increased the risk of depression by 78% compared to those without heart disease.

Although the patients with hyperlipidemia taking statins appeared to have a 37% reduced risk of depression compared to those not taking statins, this finding did not reach statistical significance. One weakness in the adjusted analyses was that the authors did not account for smoking, obesity or alcohol use in the cohort.

“The findings could provide some insights into the important role of preexisting hyperlipidemia in the development of new-onset depression in TBI patients,” Wee and his colleagues wrote. “We also suggest that evaluating the lipid profile in the acute stage to prevent depression developing later may be a promising strategy in the neurotrauma field.”

Reference

Wee HY, et al. Increased Risk of New-Onset Depression in Patients With Traumatic Brain Injury and Hyperlipidemia. J Clin Psychiatry. 2016; doi:10.488/JCP.14m09749.