Common heart medicine associated with lower rates of violence
Beta blockers, which are widely used to treat heart conditions and high blood pressure, are associated with a lower risk of being charged with a violent crime, according to a new register-based study from Karolinska Institutet and the University of Oxford. The results have been published in PLOS Medicine.
Beta blockers slow down the heart rate by blocking the action of hormones like adrenaline. They are used to treat several conditions including hypertension, cardiovascular events, heart failure and anxiety. The medication has also been suggested for clinical depression and aggression, but some studies have found an association with increased suicidal behaviour and the evidence is conflicting.
In the current study, the researchers have investigated psychiatric and behavioural outcomes such as hospitalisations for psychiatric disorders, suicidal behaviour, deaths from suicide, and charges of violent crime. They compared 1.4 million beta blocker users in Sweden to themselves during medicated and non-medicated periods over an eight-year period from 2006-2013. This way, they were able to account for background factors that may affect the associations, such as genetics or health history.
Periods on beta blocker treatment were associated with a 13 per cent lower risk of being charged with a violent crime, which remained consistent across the analyses. As it is an observational study, conclusions about causality should be cautious.
Manage aggression and hostility
“If the findings are confirmed by other studies, including randomised controlled trials, beta blockers could be considered as a way to manage aggression and hostility in individuals with psychiatric conditions,” says Yasmina Molero, researcher at the Department of Clinical Neuroscience and the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.
Beta blocker use was also linked to an eight per cent lower risk of hospitalisation due to a psychiatric disorder and an eight per cent increased risk of being treated for suicidal behaviour or death by suicide. However, these associations were inconsistent.
“The risk of psychiatric hospitalisation and suicidal behaviour varied depending on psychiatric diagnosis, past psychiatric problems, as well as the severity and type of the cardiac condition the beta blockers were being used to treat, suggesting no links between beta blockers and these outcomes,” says Yasmina Molero.
Cardiac problems are linked to depression
Previous research has linked severe cardiac events to an increased risk of depression and suicide, and these results might suggest that the psychological distress and other disabilities associated with serious cardiac problems, rather than the beta blocker treatment, increases the risk of serious psychiatric events.
The study was financed by The Wellcome Trust, the Swedish Research Council for Health, Working Life and Welfare, the American Foundation for Suicide Prevention, and Karolinska Institutet Funds. Coauthor Henrik Larsson has received grants from Shire Pharmaceuticals, speaker fees from Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma, and sponsorship for a conference on ADHD from Shire/Takeda Pharmaceuticals, all outside the submitted work.
Publication
“Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden”. Yasmina Molero, Sam Kaddoura, Ralf Kuja-Halkola, Henrik Larsson, Paul Lichtenstein, Brian M. D’Onofrio, Seena Fazel. PLOS Medicine, online 31 January 2023, doi: 10.1371/journal.pmed.1004164.