Links Between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk

This narrative review, with an emphasis on children and adolescents, addresses the link between 5 psychiatric disorders and cardiovascular risk: attention deficit hyperactivity disorder, autism spectrum disorders, anxiety disorders, depression, and bipolar disorders. The evidence regarding cardiovascular risk factors, noninvasive measures of early atherosclerosis, and cardiovascular disease prevalence and/or mortality is summarized. Whereas multiple studies have examined stimulant treatment of attention deficit hyperactivity disorder in relation to cardiovascular death, and autonomic-vagal function in autism spectrum disorders, little is known regarding atherosclerotic cardiovascular disease in patients with these conditions. For anxiety disorders, there is a gap in knowledge regarding cardiovascular risk in clinical samples of youth. In contrast to the adult literature, there are few studies regarding depression diagnoses, as opposed to self-reported symptoms, in relation to cardiovascular risk in youth. For bipolar disorder, youth studies focused on epidemiologic samples and various mood-stabilizing medications are warranted. General recommendations for future research include: larger samples, prospective repeated measures studies, and the integration of clinical and biological mediators with noninvasive measures of early atherosclerosis. Overall, the potential implications of cardiovascular risk factors are multiplied in youth with psychiatric conditions, because these risk factors are relevant not only to cardiovascular disease but to mental health and cognitive function. A shift in thinking regarding treatment paradigms for youth with psychiatric disorders is warranted. Pending changes in clinical practice guidelines and care delivery models, patients, families, clinicians, and policy makers can act on currently available information to reduce cardiovascular risk among children and adolescents with psychiatric disorders.