C-reactive protein and cardiovascular risk in bipolar disorder patients: A systematic review
Victoria S Marshe1, Shamira Pira2, Outi Mantere3
1Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada.
Insights
Elevated C-reactive protein (CRP) in bipolar disorder (BD) is linked to increased cardiovascular risk factors like obesity and metabolic syndrome. Further research is needed to confirm causality and explore anti-inflammatory treatments for bipolar disorder patients.
Area of Science:
- Psychiatry
- Cardiology
- Immunology
Background:
- Bipolar disorder (BD) is associated with a high prevalence of cardiovascular disease (CVD) and related risk factors.
- Inflammatory markers are increasingly recognized as potentially linking BD and CVD.
- C-reactive protein (CRP) is a key clinical inflammatory marker relevant to this association.
Purpose of the Study:
- To systematically review and synthesize existing literature on the association between C-reactive protein (CRP) and cardiovascular disease (CVD) and its risk factors in patients with bipolar disorder (BD).
Main Methods:
- A systematic literature search was conducted across MEDLINE, Embase, and PsychInfo for English-language articles published before April 2017.
- Studies were included if they investigated the relationship between CRP levels and CVD or cardiovascular risk factors specifically in individuals diagnosed with BD.
Main Results:
- Fifteen studies were included, primarily cross-sectional, showing heterogeneity in investigated CVD risk factors.
- Elevated CRP levels were consistently associated with increased risk of metabolic syndrome, higher body mass index, larger waist circumference, and obesity in BD patients.
- Associations between CRP and other factors like fasting glucose, insulin, triglycerides, total cholesterol, and HDL cholesterol were inconsistent. Atypical antipsychotic use may influence these findings.
Conclusions:
- Systemic inflammation, indicated by elevated CRP, may be a shared mechanism contributing to both bipolar disorder and increased cardiovascular risk.
- Further longitudinal research is essential to establish causality and investigate actual cardiovascular disease outcomes in BD.
- Investigating anti-inflammatory treatments, both non-pharmacological and pharmacological, is recommended for patients with elevated CRP to potentially mitigate cardiovascular risk in BD.
Objectives:
New research is revealing a strong association between inflammatory markers with bipolar disorder (BD), potentially due to the high prevalence of cardiovascular disease and cardiovascular risk factors in BD. We aimed to synthesize the literature examining the association between the clinically most relevant inflammatory marker, C-reactive protein (CRP) and cardiovascular disease and cardiovascular risk factors in patients with BD.
Methods:
MEDLINE, Embase and PsychInfo were systematically searched for all relevant English language articles published prior to April 2017. Articles were included if they examined the association between CRP and cardiovascular risk factors/disease in BD.
Results:
Fifteen relevant articles were retrieved. Studies were mostly cross-sectional and heterogeneous in the cardiovascular risk factors investigated. Overall, elevated CRP was associated with increased risk of metabolic syndrome, elevated body mass index, higher waist circumference, and obesity. CRP was inconsistently associated with elevated fasting glucose, insulin levels, serum triglycerides, total cholesterol levels, and low high density lipoprotein (HDL) levels. Atypical antipsychotic use may mediate some of these effects. No study examined CRP's association with actual cardiovascular disease (e.g. coronary artery disease) in BD.
Conclusions:
In BD, CRP is associated with increases in several cardiovascular risk factors, suggesting that systemic inflammation could be a shared driving force for both outcomes of BD and cardiovascular risk. Further longitudinal research is needed in this area to verify causality, including an examination of actual cardiovascular disease. Non-pharmacological and pharmacological treatments with anti-inflammatory effects should also be investigated, particularly in patients with increased CRP, for their potential to reduce cardiovascular risk in BD.
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