Association Between Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Suicide

Mamdani, Muhammad; Gomes, Tara; Greaves, Simón; Manji, Selina; Juurlink, David N.; Tadrous, Mina; Kennedy, Sidney H.; Antoniou, Tony

doi:10.1001/jamanetworkopen.2019.13304

Cited by 21 publications

(48 citation statements)

References 22 publications

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“…This sensitivity analysis replicated the covariate selection methods of Mamdani and colleagues,4 rather than using the same variables included in their model, regardless of the covariates standardized differences found in the present study. Third, to determine whether population differences in matching variables in the VHA case cohort contributed to the results, the same analyses were conducted without matching on diabetes, hypertension, sex, or age.…”

supporting

confidence: 83%

“…Treatment Modality and Suicide Risk Among Veterans From 2015 to 2017 score equal to 1; and (4) at least 1 hospitalization and a Charlson comorbidity index score greater than or equal to 2. These methods are consistent with the methods used byMamdani and colleagues 4. Sensitivity analyses that created a VHA-specific model used a Charlson Comorbidity Index Score that also included outpatient diagnoses.…”

mentioning

confidence: 69%

“….1 attenuated the crude OR to a similar magnitude as the full list of covariates included in the adjusted analysis of Mamdani et al4 (OR, 0.985; 95% CI, 0.835-1.161) 4. Adjusting for the quantity and temporal proximity of ACEI or ARB exposure in the 100 days before the veterans'…”

mentioning

confidence: 88%

“…Mamdani and colleagues, 4 could have implications for VHA prescribing patterns. Prior to making operational decisions based on the findings of Mamdani et al, 4 evaluation of whether these findings are also observed in the VHA veteran population is warranted. The aim of this study was to evaluate whether exposure to ARBs is associated with differential suicide risk compared with ACEIs among veterans in VHA care.…”

Section: Replication Of the Association Between Hypertension Medicatimentioning

confidence: 99%

“…with exposure for categorical variables. Total No.for continuous variables is presented in the first row.DiscussionUsing a nested case-control study among 1309 veteran VHA user suicide decedents between 2015 and 2017, the suicide risk among veterans with an ARB prescription did not significantly differ from those with an ACEI prescription.In comparison, using administrative claims databases in Ontario, Canada, Mamdani and colleagues4 documented the odds of suicide among older patients receiving ARBs as 1.63 (95% CI, 1.33-2.00) times that of those receiving ACEIs, after adjusting for potential confounders. As described by Katz,26 these findings indicate a serious but rare adverse drug effect whose replication may help synthesize scientific evidence and inform potential suicide prevention policies.…”

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confidence: 99%

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Hypertension Treatment Modality and Suicide Risk Among Veterans in Veterans Health Administration Care From 2015 to 2017

et al. 2020

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IMPORTANCE The Veterans Health Administration (VHA) serves a population of veterans with a high prevalence of comorbid health conditions and increased risk for suicide. OBJECTIVE To replicate the findings of a previous study and assess whether exposure to angiotensin receptor blockers (ARBs) is associated with differential suicide risk compared with angiotensin-converting enzyme inhibitors (ACEIs) among veterans receiving VHA care. DESIGN, SETTING, AND PARTICIPANTS This nested case-control design included all suicide decedents from 2015 to 2017 with a VHA inpatient or outpatient encounter in the prior year and with either an active ACEI or ARB prescription in the 100 days prior to death. Using a 4:1 ratio, controls were matched to cases by age, sex, and hypertension and diabetes diagnoses. Controls were alive at the time of the death of the matched case, had a VHA encounter within the previous year, and had either an active ACEI or ARB medication fill within 100 days before the death of the matched case. EXPOSURES An active ACEI or ARB prescription within 100 days before the death of the case. MAIN OUTCOMES AND MEASURES Cases were suicide decedents from 2015 to 2017 per National Death Index search results included in the Veteran Affairs/Department of Defense Mortality Data Repository. RESULTS Among 1309 cases, the median (interquartile range [IQR]) age was 68 (60-76) years and among 5217 controls, the median (IQR) age was 67 (60-76) years, and 1.9% of veterans in both groups were female. ARBs were received by 20.2% of controls and 19.6% of cases; ACEIs were received by 79.8% of controls and 80.4% of cases. The crude suicide odds ratio for ARBs vs ACEIs was 0.966 (95% CI, 0.828-1.127). Controlling for covariates, the adjusted odds ratio for ARBs was 0.985 (95% CI, 0.834-1.164). Sensitivity analyses using only those covariates that differed significantly between groups, restricting to veterans ages 65 and older, dropping matching criteria, and adjusting for the quantity and temporal proximity of ACEI and ARB exposure in the 100 days prior to the index date, had consistent findings. CONCLUSIONS AND RELEVANCE This case-control study did not identify differences in suicide risk by receipt of ARBs vs ACEIs in analyses specific to veterans receiving VHA care in contrast with findings from the referent study.

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supporting

confidence: 83%

mentioning

confidence: 69%

mentioning

confidence: 88%

Section: Replication Of the Association Between Hypertension Medicatimentioning

confidence: 99%

mentioning

confidence: 99%

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Hypertension Treatment Modality and Suicide Risk Among Veterans in Veterans Health Administration Care From 2015 to 2017

et al. 2020

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Concerns Raised by a Study of Suicide as an Adverse Drug Effect—Replicating Findings From Real-World Data

Katz

2019

JAMA Netw Open

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Mamdani et al 1 reported on a nested case-control study using real-world data that finds that patients receiving angiotensin receptor blockers (ARBs) are associated with a greater risk of suicide than those receiving angiotensin-converting enzyme inhibitors (ACEIs). This is the sort of finding-the identification of a serious but rare adverse drug effect-that could only come from real-world data.The authors note that their conclusions should be viewed as preliminary, with a need for confirmation through additional research, at least in part because there may be differences in how the medications are used between geographic areas or health systems. Overall, the findings are important, but they require replication based on data from other populations and a synthesis of the Downloaded From: https://jamanetwork.com/ on 07/11/2020

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Errors in Abstract, Results, and Table 2

2020

JAMA Netw Open

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Association Between Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, and Suicide

Cited by 21 publications

References 22 publications

Hypertension Treatment Modality and Suicide Risk Among Veterans in Veterans Health Administration Care From 2015 to 2017

Hypertension Treatment Modality and Suicide Risk Among Veterans in Veterans Health Administration Care From 2015 to 2017

Concerns Raised by a Study of Suicide as an Adverse Drug Effect—Replicating Findings From Real-World Data

Errors in Abstract, Results, and Table 2

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