Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities

Bipolar disorder (BD) is associated with excessive prevalence and premature onset of cardiovascular disease (CVD). This association is observed internationally in clinical as well as predominantly untreated epidemiologic samples. A number of factors might explain this association in part, including excessive rates of traditional cardiovascular risk factors (CVRFs), suboptimal lifestyle behaviour s relating to physical activity, nutrition, and use of alcohol, tobacco, and drugs, and the use of psychiatric medications with propensity for causing CVRFs. Nonetheless, compelling findings from predominantly untreated representative population samples indicate the increased risk of CVD among people with BD likely exceeds what can be explained by these factors. In this narrative review, I summarize the clinical epidemiology linking BD and CVD, and the previously reviewed biological processes that might be contributory, including excessive inflammation, and summarize a growing body of literature from the author's research group regarding vascular factors among adolescents with BD, a group of patients that is highly amenable to the potential benefits of preventive cardiology approaches. Finally, I elaborate on a hypothesis that microvascular phenotypes might explain in part the "extra" risk of CVD that is not explained by traditional CVRFs.