Cardiovascular drugs and the risk of suicide: a nested case-control study.
OBJECTIVE
During the past 30 years, various cardiovascular drugs have been implicated as causes of depression or suicide. Although the evidence for causal relationships has generally been conflicting, both beta-blockers and angiotensin-converting-enzyme inhibitors (ACE-inhibitors) have been related to depression. Lipid-lowering therapies and calcium-channel blockers have also been linked to an increased risk of suicide. In this study, we investigated the possible association between the use of cardiovascular drugs and suicide using population-based register data.


METHODS
We performed a nested case-control study in the county of Funen, Denmark, that consisted of 743 cases of completed suicide identified in a Death Registry for the period 1991-1998 and 14,860 age- and sex-matched controls. Information on previous drug use was retrieved from prescription data and the association between suicide and use of cardiovascular drugs was analysed by conditional logistic regression. Previous exposures to other drugs were used as proxies for potential confounding co-morbidities, including the use of psychotropic drugs to indicate psychiatric illness.


RESULTS
The risk of suicide was not associated with current exposure to lipid-lowering drugs [odds ratio (OR): 1.21; 95% confidence interval (95% CI): 0.45-3.28), calcium-channel blockers (OR: 0.96; 95% CI: 0.63-1.48), beta-blockers (OR: 0.76; 95% CI: 0.47-1.25) or ACE-inhibitors (OR: 1.11; 95% CI: 0.68-1.83). Suicide risk was associated with current angiotensin-receptor antagonist use (OR: 3.52; 95% CI: 1.33-9.30) based on five of the cases exposed.


CONCLUSIONS
With the exception of the imprecise risk associated with current use of angiotensin-receptor antagonists, the results from our study do not support the hypothesis that other cardiovascular drugs are associated with an increased the risk of suicide.
Callréus
Torbjörn
T
Institute of Public Health, Research Unit of Clinical Pharmacology, University of Southern Denmark, J.B. Winsloews Vej 9A, 5000, Odense C, Denmark. tcallreus@health.sdu.dk
Agerskov Andersen
Ulla
U
Hallas
Jesper
J
Andersen
Morten
M
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D002121:Calcium Channel Blockers / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D003718:Denmark; D003863:Depression / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors