Callréus Torbjörn, Agerskov Andersen Ulla, Hallas Jesper, Andersen Morten
Institute of Public Health, Research Unit of Clinical Pharmacology, University of Southern Denmark, J.B. Winsloews Vej 9A, 5000, Odense C, Denmark.
Eur J Clin Pharmacol. 2007 Jun;63(6):591-6. doi: 10.1007/s00228-007-0293-5. Epub 2007 Mar 20.
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.
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.
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.
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.
在过去30年里，各种心血管药物被认为是导致抑郁或自杀的原因。尽管因果关系的证据通常相互矛盾，但β受体阻滞剂和血管紧张素转换酶抑制剂（ACE抑制剂）都与抑郁症有关。降脂疗法和钙通道阻滞剂也与自杀风险增加有关。在本研究中，我们使用基于人群的登记数据调查了心血管药物使用与自杀之间的可能关联。
我们在丹麦菲英岛进行了一项巢式病例对照研究，包括1991年至1998年期间在死亡登记处确定的743例自杀死亡病例和14860例年龄和性别匹配的对照。从处方数据中检索以前的药物使用信息，并通过条件逻辑回归分析自杀与心血管药物使用之间的关联。以前接触其他药物被用作潜在混杂共病的替代指标，包括使用精神药物来表明精神疾病。
自杀风险与当前使用降脂药物[比值比（OR）：1.21；95%置信区间（95%CI）：0.45 - 3.28]、钙通道阻滞剂（OR：0.96；95%CI：0.63 - 1.48）、β受体阻滞剂（OR：0.76；95%CI：0.47 - 1.25）或ACE抑制剂（OR：1.11；95%CI：0.68 - 1.83）无关。基于5例暴露病例，自杀风险与当前使用血管紧张素受体拮抗剂有关（OR：3.52；95%CI：1.33 - 9.30）。
除了当前使用血管紧张素受体拮抗剂相关的不明确风险外，我们的研究结果不支持其他心血管药物与自杀风险增加有关的假设。
