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. 2013 Apr 18;3(4):e002373.
doi: 10.1136/bmjopen-2012-002373. Print 2013.

Cardiovascular mortality in bipolar disorder: a population-based cohort study in Sweden

Jeanette Westman  1 , Jonas Hällgren, Kristian Wahlbeck, David Erlinge, Lars Alfredsson, Urban Osby
Affiliations

Cardiovascular mortality in bipolar disorder: a population-based cohort study in Sweden

Jeanette Westman et al. BMJ Open. .

Abstract

Objective: To estimate the cardiovascular mortality among persons with bipolar disorder in Sweden compared to the general population.

Design: Population register-based cohort study with a 20-year follow-up.

Setting: Sweden.

Participants: The entire population of Sweden (n=10.6 million) of whom 17 101 persons were diagnosed with bipolar disorder between 1987 and 2006.

Main outcome measures: Mortality rate ratios (MRR), excess mortality (excess deaths), cardiovascular disorder (CVD) and specifically cerebrovascular disease, coronary heart disease, acute myocardial infarction, sudden cardiac deaths and hospital admission rate ratio (ARR).

Results: Persons with bipolar disorder died of CVD approximately 10 years earlier than the general population. One third (38%) of all deaths in persons with bipolar disorder were caused by CVD and almost half (44%) by other somatic diseases, whereas suicide and other external causes accounted for less than a fifth of all deaths (18%). Excess mortality of both CVD (n=824) and other somatic diseases (n=988) was higher than that of suicide and other external causes (n=675 deaths). MRRs for cerebrovascular disease, coronary heart disease and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population. Despite the increased mortality of CVD, hospital admissions (ARR) for CVD treatment were only slightly increased in persons with bipolar disorder when compared to the general population.

Conclusions: The increased cardiovascular mortality in persons with bipolar disorder calls for renewed efforts to prevent and treat somatic diseases in this group. Specifically, our findings further imply that it would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder.

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Figures

Figure 1
Figure 1
International Classification of Diseases coding and classification of disease and mortality.
Figure 2
Figure 2
Mortality rate ratios (MRR) by age at death in persons with bipolar disorder compared to the general population for (A) all causes of death, (B) cardiovascular death, (C) other somatic death, (D) suicide and other external causes of death, (E) cerebrovascular disease, (F) coronary heart disease, and (G) acute myocardial infarction. All causes of death presented with the same scale for reasons of comparison.
Figure 3
Figure 3
Mortality per 1000 person-years in persons with bipolar disorder and the general population adjusting for sex and calendar year for (A) coronary heart disease, (B) acute myocardial infarction, and (C) cerebrovascular disease. All mortality rates presented with the same scale for reasons of comparison.
Figure 4
Figure 4
Five-year survival of cardiovascular disease in persons with bipolar disorder after discharge from first cardiovascular admission stratified by age at hospital contact.
See this image and copyright information in PMC

References

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    1. Laursen TM, Nordentoft M. Heart disease treatment and mortality in schizophrenia and bipolar disorder—changes in the Danish population between 1994 and 2006. J Psychiatr Res 2011;45:29–35 - PubMed
    1. Osby U, Brandt L, Correia N, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001;58:844–50 - PubMed

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