Risk of Suicide in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Population-Based Study

Abstract 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 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 January 1, 2004, and December 31, 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 December 31, 2021, whichever occurred first. Results This study included 37,912 individuals with ASCVD and 189,560 matched controls. During a median follow-up of 11.3 years, 1,250 suicides occurred. The incidence rate of suicide per 1,000 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 Conclusions 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.