Anger management: Statins decrease aggression in men, increase it in women

Statins decreased aggression in adult men and increased aggression in postmenopausal women, according to a randomized, double-blind, placebo-controlled trial published online July 1 in PLOS One.

Lead researcher Beatrice A. Golomb, MD, PhD, of the University of California, San Diego, and colleagues randomized 1,016 adults to receive a statin (simvastatin or pravastatin) or placebo for six months. The patients included 692 men who were at least 20 years old and 324 surgically or chronologically postmenopausal women. They were excluded if they had cardiovascular disease, cancer (except for nonmelanoma skin cancer), HIV, diabetes, fasting blood glucose >142 mg/dL or low density lipoprotein (LDL) cholesterol <115 mg/dL or >190 mg/dL.

The groups were well balanced; the mean age was 57 years, 81 percent of patients were white and 68 percent were male.

To measure aggression, Golomb and colleagues used the OASMa (Overt-Aggression-Scale-Modified) scale, which measures behavioral aggression such as verbal assaults, assaults against objects, assault against others and assaults against self.

For women, statins increased aggression, especially for women who were 45 or older and those who were less aggressive at baseline.

"Those with evidence of aggression at baseline have other forces acting on aggression, and may be subject to more variance in aggression arising from sources distinct from statins," wrote Golomb and colleagues.

For men, statins decreased aggression, particularly for those taking pravastatin as well as younger men and men who were less aggressive. However, three men who took statins had a large increase in aggression, according to the researchers.

There were two deaths in the study. One participant in the pravastatin group committed suicide, while one participant in the placebo group was found dead in his room. Although no autopsy was performed, the person was determined to have heart failure. In addition, one woman in the pravastatin group discontinued the study at her husband’s urging because she had an adverse behavioral change. The woman told researchers that the changes led to her being fired from her job.

All groups had a lowering of LDL cholesterol, and the mean decrease was significantly greater with simvastatin compared with pravastatin.