ScholarWorks@성균관대학교

초록

Aims Myocardial infarction (MI) and stroke significantly affect health, quality of life, and socioeconomic stability. We investigated the association of MI and stroke with the risk of suicide.Methods and results This nationwide population-based cohort study used Korean National Health Insurance Service data on all patients diagnosed with atherosclerotic cardiovascular disease (ASCVD), defined as a composite of MI or stroke, between 1 January 2004, and 31 December 2008. For each patient, five age- and sex-matched controls were selected. All participants were followed up from diagnosis (or the corresponding entry date for controls) until suicide, other causes of death, or 31 December 2021, whichever occurred first. This study included 37 912 individuals with ASCVD and 189 560 matched controls. During a median follow-up of 11.3 years, 1250 suicides occurred. The incidence rate of suicide per 1000 person-years were 0.737 and 0.497 among individuals with and without ASCVD, respectively. Multivariable analysis showed a significantly higher risk of suicide for individuals with ASCVD [hazard ratio (HR), 1.43; 95% confidence interval (CI), 1.24-1.65], with HRs of 1.42 (95% CI, 1.14-1.78) for MI and 1.47 (95% CI, 1.23-1.76) for stroke. The risk of suicide increased further in individuals with both MI and stroke (HR, 1.85; 95% CI, 1.07-3.21). The association between ASCVD and increased suicide risk was consistent across age, sex, and a history of depressive disorder.Conclusion Individuals with ASCVD have increased risks of suicide. Our findings suggest the importance of screening and preventing suicidal ideation in individuals with ASCVD to improve prognosis. Atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction (MI) and stroke, is associated with psychological distress, such as depression, which may worsen patient outcomes, and data from a comprehensive nationwide database from the Republic of Korea revealed that individuals with ASCVD have an increased risk of suicide.During a follow-up period of 11.3 (interquartile range, 11.0-11.6) years, 1250 suicide cases were reported. This study shows that individuals in the Republic of Korea who have ASCVD, including MI and stroke, have a notably higher risk of suicide than individuals without this condition. This study further highlights that the risk is even greater in individuals who have both MI and stroke, emphasizing the need for mental health interventions in this population. In the subgroup analyses by age, sex, and history of depressive disorders, the results were similar to those of the main analysis, indicating little heterogeneity in the association between ASCVD and suicide risk across subsets of participants.Physicians should recognize the heightened suicide risk among patients with ASCVD and integrate mental health screening into their care. Early identification and intervention for psychological distress in such individuals could improve both their mental well-being and overall prognosis.

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