Source: Goldstein BI, et al. J Clin Psychiatry 2015;76:163-169.

Although perhaps not widely recognized, bipolar disorder (BPD) is associated with an excessive risk of cardiovascular disease (CVD). Not only is CVD more prevalent, but it occurs as much as a decade earlier than comparators without BPD. Some of this risk is attributed to utilization of pharmacotherapies that are known to be diabetogenic (e.g., mood stabilizers), but this is insufficient to fully explain the observed increased CVD risk.

To better clarify risk of CVD in BPD patients, an analysis was performed of persons in the NESARC epidemiologic survey (National Epidemiologic Survey on Alcohol and Related Conditions). The population studied included persons with BPD (n = 1439), major depressive disorder (n = 4396), and controls (n = 26,266). The incidence of CVD was compared in two survey “waves,” the first performed in 2001-2002 and the next performed in 2004-2005.

Even within this very short window of observation, the odds ratio for new-onset CVD among persons with BPD was over 2.5 compared to controls. In contrast, persons with major depressive disorder did not have an incidence of CVD that differed meaningfully from controls.

These concerning data show a nearly three-fold increased risk of new-onset CVD in persons with BPD, despite being controlled for commonly recognized risk factors (e.g., age, smoking, HTN, obesity). Equally alarming is the observation that the mean age of CVD onset in BPD patients was 14-17 years earlier than controls! Clinicians should heighten their vigilance for addressing CVD risk factors among persons with BPD.