Cardiovascular morbidity and mortality in bipolar disorder

Abstract

Background: There has been considerable interest in the elevated risk of cardiovascular disease associated with serious mental illness. Although the contemporary literature has paid much attention to major depression and schizophrenia, focus on the risk of cardiovascular mortality for patients with bipolar disorder has been more limited, despite some interest in the historical literature.

Methods: We reviewed the historical and contemporary literature related to cardiovascular morbidity and mortality in bipolar disorder.

Results: In studies that specifically assess cardiovascular mortality, bipolar disorder has been associated with a near doubling of risk when compared with general population estimates. This may be explained by the elevated burden of cardiovascular risk factors found in this population. These findings predate modern treatments for bipolar disorder, which may further influence cardiovascular risk.

Conclusions: Given the substantial risk of cardiovascular disease, rigorous assessment of cardiovascular risk is warranted for patients with bipolar disorder. Modifiable risk factors should be treated when identified. Further research is warranted to study mechanisms by which this elevated risk for cardiovascular disease are mediated and to identify systems for effective delivery of integrated medical and psychiatric care for individuals with bipolar disorder.

Figure 1. Excess deaths in bipolar disorder

This graph uses aggregate data from one of the largest studies of mortality in mood disorders to illustrate the primary causes of excess death with bipolar disorder (Osby et al. 2001). In their sample, a total of 2,129 excess deaths were identified in those with bipolar disorder, 700 of which were attributable to vascular disease (592 cardiovascular, 108 cerebrovascular). Thus, nearly 1/3 of the excess deaths were attributable to vascular disease alone. The top four causes of excess deaths are illustrated in this figure.