Suicide risks associated with cardiovascular disease in persons with alcohol use disorder

People with alcohol use disorder (AUD) have high risks of both cardiovascular disease (CVD) and suicide. We examined how CVD contributes to their long-term suicide risk in a large population-based cohort, which may help guide preventive interventions.

A national cohort study was conducted of all 537,802 people with AUD in Sweden during 1973-2017. CVD and suicide deaths were ascertained from nationwide records through 2018. Cox regression was used to determine hazard ratios (HRs) for suicide death associated with ischemic heart disease, stroke, heart failure, or atrial fibrillation, and a composite outcome ("any CVD"), adjusting for other mental disorders and sociodemographic factors.

Any CVD was associated with a 1.4-fold risk of death by suicide (adjusted HR, 1.44; 95 % CI, 1.35-1.54). Adjusted HRs by specific comorbidities were: ischemic heart disease, 1.26 (95 % CI, 1.16-1.38); stroke, 1.45 (1.31-1.61); heart failure, 1.49 (1.31-1.69); and atrial fibrillation, 1.52 (1.36-1.70). These risks were similarly elevated in men and women.

In this large national cohort with AUD, CVD was associated with a ∼40 % higher risk of suicide death. Clinical care for persons with AUD should integrate mental health and prevention and treatment of CVD comorbidities to support their long-term health and survival.