Certain Heart Meds Linked to Suicide
Researchers suggest 'preferential use' of ACE inhibitors
Angiotensin receptor blockers (ARBs) were associated with a higher risk of death by suicide compared with angiotensin-converting enzyme (ACE) inhibitors, according to a Canadian population-based study of seniors.
The excess risk (adjusted OR 1.63, 95% CI 1.33-2.00) persisted even after a sensitivity analysis excluding people with a history of self-harm (OR 1.60, 95% CI 1.29-1.98), reported Tony Antoniou, PharmD, PhD, of St. Michael's Hospital in Toronto, and colleagues.
"Preferential use of ACEIs [ACE inhibitors] over ARBs should be considered whenever possible, particularly in patients with severe mental health illness," the group suggested in their study published online in JAMA Network Open.
Antoniou's team had performed a nested case-control study using Canadian administrative claims databases with records spanning 1995-2015. People included were 66 years and older who died by suicide within 100 days of being prescribed an ACE inhibitor or ARB (n=964) matched 1:4 to controls who had died of other causes (n=3,856). Excluded were individuals getting both classes of drugs during this period.
"This is the sort of finding -- the identification of a serious but rare adverse drug effect -- that could only come from real-world data," according to an accompanying editorial by Ira Katz, MD, PhD, of the Philadelphia VA Medical Center.
"The strength of the methods, the importance of preventing suicide, and the number of people exposed to ARBs all support the need to encourage additional studies and to translate the combined findings into guidance about prescribing," he wrote.
Mechanisms linking ARBs to mental health conditions require further investigation as well, Antoniou and colleagues said./.../
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