SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
The association of statin use with the risk of anxiety: A systematic review and meta-analysis
Provisionally accepted
- 1University of Glasgow, Glasgow, United Kingdom
- 2Daping Hospital, Chongqing, China
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Background Statins are widely prescribed for the primary and secondary prevention of cardiovascular diseases, given their efficacy in lowering low-density lipoprotein cholesterol levels and reducing the risk of cardiovascular events. However, statins may exert effects on the central nervous system. Previous studies have hypothesized that statin use may exert protective effects against anxiety via mechanisms including anti-inflammatory activity and improved endothelial function. Conversely, observational studies have also reported associations between statin use and increased anxiety symptoms. To date, findings on the association between statin use and anxiety risk have been inconsistent. Therefore, this systematic review and meta-analysis aimed to systematically search and assess the available evidence, clarify the association between statin use and the risk of anxiety, and offer evidence-based guidance for clinical practice. Methods We searched PubMed, Web of Science, Embase, and the Cochrane Library for studies investigating the association between statin use and anxiety risk, with the search period ranging from the inception of each database to January 2026. Studies were screened against predefined inclusion criteria, and relevant data were extracted. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was employed to assess the risk of bias in included non-randomized studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled with a random-effects model. The study protocol was retrospectively registered in PROSPERO (Registration number:CRD420261291901). Results A total of five studies with 1,919,059 participants were included. The meta-analysis showed that statin use was not associated with an increased risk of anxiety disorders (HR = 0.75,95% CI (0.55,1.04), P = 0.08). Subgroup analyses revealed that statin use was associated with a reduced risk of anxiety only in studies with a sample size < 10,000 (P < 0.05). No significant association was observed in other subgroups, including those stratified by region or study design, notably, studies with a sample size > 10,000 also showed no significant effect (P > 0.05). Conclusion The existing evidence suggests that statin use may not be associated with the risk of developing anxiety. Given the limitations of this study, future large-scale, multi-center, and prospective cohort studies are warranted to validate these findings
Keywords: Anxiety, Anxiety Disorders, Meta-analysis, Statins, Systematic review
Received: 19 Dec 2025; Accepted: 02 Feb 2026.
Copyright: © 2026 Yan, Deng, Li, Fu, Gong, Zhang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Feng Zhang
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