Risk factors for early cardiovascular mortality in patients with bipolar disorder

Tsai, Shang‐Ying; Lee, Chao-Hsien; Chen, Pao‐Huan; Chung, Kuo Hsuan; Huang, Shou-Hung; Kuo, Cheng‐Deng; Wu, Wei

doi:10.1111/pcn.12538

Cited by 18 publications

(11 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Increased heart rate (HR) observed in the acute phase of BD can be considered a risk factor for early cardiovascular mortality in bipolar disorder, perhaps due to autonomic imbalance (Tsai et al, 2017). In the present study, we report on change in heart rate variability (HRV) -a psychophysiological marker of mental and physical wellbeing (Kemp et al, 2017a) -in bipolar patients in the manic phase at admission and in the same patients during euthymia at discharge.…”

Section: Introductionmentioning

confidence: 88%

Heart rate variability in patients with bipolar disorder: From mania to euthymia

Wazen

Gregório

Kemp

et al. 2018

Journal of Psychiatric Research

View full text Add to dashboard Cite

Bipolar Disorder (BD) is characterized by the occurrence of mania alternating with euthymia. The aim of the present study was to investigate the impact of BD on the autonomic nervous system, as indicated by heart rate variability (HRV). The study was registered in the Clinical Trials Registration (NCT01272518). Nineteen hospitalized, male patients (age: 34.0 ± 12.3 years) with type I BD were assessed during mania and at discharge on euthymia. HRV data were collected during 20- minutes in supine position at rest, on spontaneous breathing, using the Polar RS 800 CX frequencymeter. HRV measures included variables in time, frequency and non-linear domains. Psychiatric conditions were evaluated by the Mini International Neuropsychiatric Interview (MINI) and the Bech-Rafaelsen mania scale (BRMS). Time domain measures of RMSSD (Cohen's d = 0.668) and pNN50 (Cohen's d = 0.688) increased from first to second assessments. The high-frequency component (HFms2) also increased (Cohen's d = 0.586), while the LF/HF ratio decreased (Cohen's d = 0.785). Non-linear domain measures including the SD1 component (Cohen's d = 0.668), and the SD1/SD2 ratio (Cohen's d = 1.2934) extracted from the Poincare plot analysis increased from first to second assessment. The variables Lmean (Cohen's d = 0.9627), Lmax (Cohen's d = 1.2164), REC% (Cohen's d = 1.0595) and EntShannon (Cohen's d = 1.0607) were higher in mania. By contrast, ApEn (Cohen's d = 0.995) and EntSample (Cohen's d = 1.189) were less during mania, all reflecting ANS improvement. Findings are interpreted in the context of recently published models relating to neurovisceral integration across the continuum of time, and the implications for the future health and wellbeing of patients are considered.

show abstract

Section: Introductionmentioning

confidence: 88%

Heart rate variability in patients with bipolar disorder: From mania to euthymia

Wazen

Gregório

Kemp

et al. 2018

Journal of Psychiatric Research

View full text Add to dashboard Cite

show abstract

“…In addition, obesity, diabetes, migraine, and some infectious diseases are more prevalent among BD patients (McIntyre et al 2007;Almeida et al 2018). With BD, risk of myocardial infarction was 37% greater (88% among women), stroke 60%, and congestive heart failure nearly 230% greater than in age-matched general populations (Wu et al 2015;Fornaro et al 2017;Tsai et al 2017). Cardiovascular diseases are particularly frequent in association with BD disorder (Table 2) (Correll et al 2017).…”

Section: General-medical Morbidity and Mortalitymentioning

confidence: 99%

“…Cardiovascular diseases are particularly frequent in association with BD disorder (Table 2) (Correll et al 2017). Mediating factors include obesity, inactivity, diabetes or metabolic syndrome, and increased inflammatory factors-all with increased prevalence among BD patients (Vancampfort et al 2013;Halaris 2017;Tsai et al 2017), and at least in part attributable to treatments which may contribute to these risks (Baldessarini 2013;Correll et al 2015). With many general-medical disorders, BD patients have more adverse clinical outcomes and diminished life-expectancy, with all-cause mortality up to 15-times above general population rates, and rising (McIntyre et al 2007;Ösby et al 2018;Hällgren et al 2018;Staudt-Hansen et al 2019).…”

Section: General-medical Morbidity and Mortalitymentioning

confidence: 99%

Bipolar depression: a major unsolved challenge

Baldessarini

Vázquez

Tondo

2020

Int J Bipolar Disord

168

View full text Add to dashboard Cite

Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.

show abstract

“…The pathophysiological mechanism may contribute to the association between BD and CVDs, including autonomic nervous system (ANS) dysfunction and inflammatory dysregulation . Systematic inflammation with elevated leukocyte counts and ANS dysfunction with an increasing heart rate or systolic pressure in the acute phase are found to be additional risk factors for premature CVD mortality in patients with BD . Multi‐systemic inflammation has been proposed as one underlying explanation for concurrent stroke in BD .…”

Section: Discussionmentioning

confidence: 99%

“…13,32 Systematic inflammation with elevated leukocyte counts and ANS dysfunction with an increasing heart rate or systolic pressure in the acute phase are found to be additional risk factors for premature CVD mortality in patients with BD. 33 Multisystemic inflammation has been proposed as one underlying explanation for concurrent stroke in BD. 34 Thus, an activation of inflammatory response in patients with typical-onset BD possibly manifests since young adulthood and contributes to or accelerates early vascular damage along with subsequent atherosclerosis during each mood episode.…”

Section: Discussionmentioning

confidence: 99%

High risk of silent stroke in older bipolar patients with typical‐onset age

et al. 2019

Self Cite

View full text Add to dashboard Cite

Aim Older patients with bipolar disorder (BD) are at a high risk of stroke. Silent stroke could be neglected in BD patients after middle age, particularly in those with illness onset at the young age. Therefore, we investigated the morbidity and related factors for stroke in older BD patients with typical‐onset age. Methods Older patients with bipolar I disorder (age > 50 years) and their illness onset prior to the age of 40 years were recruited. After whole‐brain magnetic resonance imaging was conducted, the patients were divided into stroke and non‐stroke groups. Clinical data were obtained by reviewing all available medical records and directly interviewing the patients along with their reliable family members. Results We recruited 62 patients with a mean age of 60.4 years and illness onset at the mean age of 28.4 years. Cerebral infarction or old stroke was observed in 24 (38.7%) patients, including 22 without any reported clinical history of stroke. That is, silent stroke (n = 22) was detected in 36.7% of 60 patients without clinical history of stroke. The stroke group had significantly higher mean numbers of lifetime mood episodes (P = 0.006) than the non‐stroke one. Logistic regression analysis showed that 10 or more prior mood episodes (odds ratio = 3.43, 95% confidence interval = 1.12–10.47, P < 0·04) was significantly associated with the occurrence of stroke. The two study groups did not exhibit any other differences in demographic and clinical variables, such as age, laboratory or physical measurements during the last acute psychiatric hospitalisation, body mass index, and substance use problems and concurrent medical diseases. Conclusions High morbidity of stroke, particularly silent stroke, could be found in older bipolar patients with typical‐onset age. In addition to traditional risk factors, the number of recurrent mood episodes in a lifetime may increase the risk of stroke in older BD patients.

show abstract

Risk factors for early cardiovascular mortality in patients with bipolar disorder

Abstract: It is suggested that systemic inflammation and sympathetic overactivity during the acute phase of BD may be risk factors for early CVD mortality.

Cited by 18 publications

References 34 publications

Heart rate variability in patients with bipolar disorder: From mania to euthymia

Heart rate variability in patients with bipolar disorder: From mania to euthymia

Bipolar depression: a major unsolved challenge

High risk of silent stroke in older bipolar patients with typical‐onset age

Contact Info

Product

Resources

About