Increased risk of hyperlipidemia in patients with major depressive disorder: A population-based study
Introduction
Hyperlipidemia involves abnormally elevated levels of one or more lipids and/or lipoproteins in the blood (triglyceride or cholesterol) and pathological lipid qualities, such as elevated levels of low-density lipoprotein, the most common form of dyslipidemia. Hyperlipidemia results from complex interactions between genetic and environmental factors and is highly involved in the process of atherosclerosis and coronary artery disease [1].
A National Health and Nutrition Examination Survey from 1988 to 1994 in the United States revealed that the prevalence of hypertriglyceridemia and low levels of high-density lipoprotein was 30% and 37.1%, respectively [2]. Another Nutrition and Health Survey in Taiwan (1993–1996) showed that the prevalence was 10.2% to 11.2% for hypercholesterolemia and 6.1% to 13.4% for hypertriglyceridemia [3].
One study in Germany found that the prevalence of metabolic syndrome in subjects with MDD was 41%, including hypertriglyceridemia, which affected 43.1%; these rates were higher than in the comparison group [4]. A follow-up study in Finland revealed that females with depressive symptoms had a 2.5-fold greater risk for metabolic syndrome, including a higher prevalence of hypertriglyceridemia (27.7% vs. 18.0%) [5]. Another study showed that a lifetime prevalence of MDD was a significant predictor for the onset of metabolic syndrome (odds ratio, 1.82) [6]. However, a large community study in Australia found no association between MDD and metabolic symptom [7]. Further, another study suggested that metabolic syndrome, particularly the obesity, high triglyceride, and low high-density lipoprotein cholesterol, predicted depressive symptoms [8].
Taiwan implemented the National Health Insurance (NHI) program starting in March 1995, offering a comprehensive, unified, and universal health insurance program to all citizens. Up to 98% of the population of Taiwan joined the NHI program by 2005, and the Bureau of NHI has contracted with 92% of the medical institutions in Taiwan. No comprehensive epidemiologic study of hyperlipidemia in MDD patients has been reported in Taiwan. Therefore, we used the health care service database to analyze the occurrence of hyperlipidemia in patients with MDD. This study tests the hypothesis of a positive association between MDD and hyperlipidemia. We first compared the prevalence of hyperlipidemia and factors associated with hyperlipidemia between patients with MDD and the general population. Second, we analyzed the associated factors for the prevalent cases of hyperlipidemia. Third, we compared the incidence of hyperlipidemia and factors associated with incident hyperlipidemia in patients with MDD and the general population from 2006 through 2010. Fourth, we analyzed risk factors for the incident cases of hyperlipidemia during the same period.
Section snippets
Sample
The National Health Research Institute medical claims database includes outpatient care, hospital inpatient care, and prescription drugs. The Institute provided us with a random sample database of 1,000,000 (about 4.5% of the total population) for health-related study. From this, we identified a sample of 766,427 subjects aged ≥ 18 years in 2005. There were no statistically significant differences in age, sex, and average insured payroll-related amount between the sample group and all enrollees.
Results
Table 1 shows the prevalence of hyperlipidemia in patients with MDD and the general population in 2005. The prevalence of hyperlipidemia in patients with MDD was higher than that in the general population (14.4% vs. 7.9%; odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.53 to 1.82; P < 0.001) in 2005. Compared with the general population, MDD patients had a higher prevalence of hyperlipidemia in the following groups: age 18–39, age 40–59, age ≥ 60; all insurance amount groups; persons living
Discussion
To our best knowledge, this is the first population-based study using the NHI database to detect the prevalence and incidence of hyperlipidemia in patients with MDD in Taiwan. We also compared the prevalence and incidence of hyperlipidemia between patients with MDD and the general population.
The results showed that the prevalence of hyperlipidemia in MDD patients (14.4%) was 1.67 times higher than in the general population (7.9%) in 2005. Our study also found that the average annual incidence
Conclusion
Patients with MDD have a higher prevalence and incidence of hyperlipidemia than the general population. Younger MDD patients and MDD patients with first-generation antipsychotic exposure or antidepressant exposure have an increased risk of hyperlipidemia compared with individuals in the general population. We must emphasize prevention, early detection, and adequate treatment of hyperlipidemia in patients with MDD. Biological and psychosocial mechanisms of these findings warrant further
Conflict of interest statement
We do not have any conflict of interest.
Acknowledgments
We thank the National Health Research Institute and the Bureau of National Health Insurance for supplying data.
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