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Long-term risk of myocardial infarction and stroke in bipolar I disorder: A population-based Cohort Study

Miguel L Prieto1, Louis A Schenck2, Jennifer L Kruse3

  • 1Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile.

Journal of Affective Disorders
|January 29, 2016
PubMed

Insights

Individuals with bipolar I disorder initially showed a higher risk of myocardial infarction (MI) and stroke. However, this increased risk for cardiovascular events was not significant after accounting for common risk factors.

Area of Science:

  • Cardiovascular epidemiology
  • Psychiatric disorders
  • Public health

Background:

  • Bipolar I disorder is a severe mental illness associated with significant morbidity.
  • Cardiovascular disease is a leading cause of mortality globally.
  • The relationship between bipolar I disorder and cardiovascular risk requires further investigation.

Purpose of the Study:

  • To determine the risk of myocardial infarction (MI) and stroke in individuals with bipolar I disorder.
  • To compare cardiovascular event rates between bipolar I disorder patients and a matched control group.

Main Methods:

  • A population-based cohort study utilized a 30-year records-linkage system (1966-1996) in Olmsted County, Minnesota.
  • 334 patients with bipolar I disorder were matched with 334 referents.
  • Cox proportional hazards models assessed hazard ratios (HR) for MI or stroke, with and without adjustment for confounders.

Main Results:

  • An elevated risk for a composite outcome of fatal or non-fatal MI or stroke was observed in bipolar I disorder patients (HR 1.54, p=0.04).
  • After adjusting for cardiovascular risk factors (alcoholism, hypertension, diabetes, smoking), the increased risk was no longer statistically significant (HR 1.19, p=0.46).

Conclusions:

  • The initial observed increased risk of MI or stroke in bipolar I disorder was not sustained after adjusting for cardiovascular risk factors.
  • Limitations include a small sample size and lack of ascertainment for psychotropic medication use.
  • Further research is needed to clarify the cardiovascular risk profile in bipolar I disorder.
Abstract

Keywords:
Bipolar disorderCardiovascular diseasesCohort studiesRisk

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