Atopic diseases/diathesis and subsequent ischemic stroke among patients with bipolar disorder: A nationwide longitudinal study

Abstract

Introduction: Previous studies have suggested that both bipolar disorder and atopy are associated with an increased risk of stroke. However, the role of atopic diseases/diathesis in the risk of stroke among patients with bipolar disorder remains unclear.

Methods: Using Taiwan's National Health Insurance Research Database, we selected 55,593 patients with bipolar disorder between 2002 and 2008, divided them into patients with atopic diseases/diathesis (n = 21,050) and patients without atopic diseases/diathesis (n = 34,543), and observed them until the end of 2011. Patients who experienced a stroke during the follow-up period were identified.

Results: Patients with bipolar disorder and atopic diseases/diathesis had an elevated risk of ischemic stroke (hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.25-1.59) compared with patients with only bipolar disorder; a dose-dependent relationship was observed between the number of allergic comorbidities and the risk of ischemic stroke (1 atopic disease, HR: 1.30, 95% CI: 1.13-1.49; 2 atopic diseases, HR: 1.59, 95% CI: 1.33-1.91; ≥ 3 atopic diseases, HR: 2.09, 95% CI: 1.50-2.91).The role of atopic diseases in the risk of hemorrhagic stroke among patients with bipolar disorder was nonsignificant (HR: 0.84, 95% CI: 0.64-1.09).

Conclusions: Patients with bipolar disorder and atopic diseases/diathesis are more prone to ischemic stroke later in life than are those without atopic diseases/diathesis. Further study is required to investigate the underlying mechanism linking atopy, bipolar disorder, and stroke.