title: Hyperlipidemia and statins use for the risk of new-onset anxiety/depression in patients with head and neck cancer: A population-based study.
abstract: OBJECTIVE
  Anxiety/depression is common among patients with head and neck cancer (HNC), and can negatively affect treatment compliance and outcome. The aim of this study was to assess the association between hyperlipidemia and the risk of new-onset anxiety/depression after the diagnosis of HNC and the influence of administering statins.
  
  
  METHODS
  A matched longitudinal cohort study of 1632 subjects (408 HNC patients with preexisting hyperlipidemia and 1224 age- and sex-matched HNC patients without hyperlipidemia) was included and analyzed by using data from Taiwan's National Health Insurance Research Database from January 1996 to December 2012. The incidence and hazard ratios (HRs) for the development of new-onset anxiety/depression were examined between the two groups. Cox proportional hazard regression was applied to estimate the relative risks of anxiety/depressive disorders adjusted for potential confounding factors. To estimate the risks of anxiety/depression in different sub-groups, a stratified analysis was also used.
  
  
  RESULTS
  HNC patients with preexisting hyperlipidemia had a higher risk for comorbidities such as hypertension, diabetes mellitus, and cardiovascular disease (P <0.001). The incidence rate of anxiety/depression in the HNC patients with preexisting hyperlipidemia was also significantly higher than that among patients without hyperlipidemia (10.78% vs 7.27%, respectively; P = 0.03). A Cox regression model revealed that preexisting hyperlipidemia was an independent risk factor for anxiety/depression (aHR, 1.96; 95% CI, 1.30-2.94). Statins use was protective against anxiety/depression among HNC patients with hyperlipidemia (aHR, 0.85; 95% CI, 0.46-1.57), especially for individuals older than 65 years and for females.
  
  
  CONCLUSIONS
  Preexisting hyperlipidemia was associated with increased risk of new-onset anxiety/depression in the HNC patients. Statins use for HNC patients with hyperlipidemia could decrease the risk of anxiety/depression, especially for those older than 65 years and for female patients.
authors.affiliation: Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
authors.forename: Chung-I
authors.initials: CI
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.
authors.forename: Hung-Cheng
authors.initials: HC
authors.lastname: Tien
authors.affiliation: Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jenny
authors.initials: J
authors.lastname: Que
authors.affiliation: Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Wei Chen
authors.initials: WC
authors.lastname: Ting
authors.affiliation: Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Po-Chun
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Hsin-Min
authors.initials: HM
authors.lastname: Wu
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Chung-Han
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Clinical Pathology, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
authors.forename: Ren-Hong
authors.initials: RH
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.|Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.|Department of Biotechnology, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology* / Q000517:prevention & control; D003863:Depression / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors