Lindberg G, Bingefors K, Ranstam J, Råstam L, Melander A
Swedish Network for Pharmacoepidemiology, Foundation, Malmö University Hospital, Sweden.
BMJ. 1998 Mar 7;316(7133):741-5. doi: 10.1136/bmj.316.7133.741.
To investigate possible associations between use of cardiovascular drugs and suicide.
Cross sectional ecological study based on rates of use of eight cardiovascular drug groups by outpatients. A population based cohort study including users of drugs to control hypertension.
The ecological study included 152 of Sweden's 284 municipalities. The cohort study included all inhabitants of one Swedish municipality who during 1988 or 1989 had purchased cardiovascular agents from pharmacies within the municipality. Six hundred and seventeen subjects (18.2%) were classified as users of calcium channel blockers and 2780 (81.8%) as non-users.
Partial correlations (least squares method) between rates of use of cardiovascular drugs and age standardised mortality from suicide in Swedish municipalities. Hazard ratios for risk of suicide with adjustments for difference in age and sex in users of calcium channel blockers compared with users of other hypertensive drugs.
Among the Swedish municipalities the use of each cardiovascular drug group except angiotensin converting enzyme inhibitors correlated significantly and positively with suicide rates. After adjustment for the use of other cardiovascular drug groups, as a substitute for the prevalence of cardiovascular morbidity, only the correlation with calcium channel blockers remained significant (r = 0.29, P < 0.001). In the cohort study, five users and four non-users of calcium channel blockers committed suicide during the follow up until the end of 1994. The absolute risk associated with use of calcium channel blockers was 1.1 suicides per 1000 person years. The relative risk, adjusted for differences in age and sex, among users versus non-users was 5.4 (95% confidence interval 1.4 to 20.5).
Use of calcium channel blockers may increase the risk of suicide.
探讨心血管药物使用与自杀之间可能存在的关联。
基于门诊患者使用八类心血管药物的比率进行的横断面生态学研究。一项基于人群的队列研究，纳入了使用药物控制高血压的患者。
生态学研究涵盖了瑞典284个城市中的152个。队列研究纳入了瑞典一个城市的所有居民，这些居民在1988年或1989年期间从该市的药店购买过心血管药物。617名受试者（18.2%）被归类为钙通道阻滞剂使用者，2780名（81.8%）为非使用者。
瑞典各城市中心血管药物使用率与年龄标准化自杀死亡率之间的偏相关（最小二乘法）。与其他高血压药物使用者相比，钙通道阻滞剂使用者自杀风险的风险比，并对年龄和性别差异进行了调整。
在瑞典各城市中，除血管紧张素转换酶抑制剂外，每类心血管药物的使用与自杀率均呈显著正相关。在对其他心血管药物组的使用进行调整后，作为心血管疾病患病率的替代指标，只有与钙通道阻滞剂的相关性仍然显著（r = 0.29，P < 0.001）。在队列研究中，直到1994年底的随访期间，有5名钙通道阻滞剂使用者和4名非使用者自杀。使用钙通道阻滞剂相关的绝对风险为每1000人年1.1例自杀。在对年龄和性别差异进行调整后，使用者与非使用者之间的相对风险为5.4（95%置信区间1.4至20.5）。
使用钙通道阻滞剂可能会增加自杀风险。
