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Cardiovascular mortality in bipolar disorder: Population-based cohort study
Tapio Paljärvi1, Kimmo Herttua2, Heidi Taipale1,3,4
1Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
Insights
Individuals with bipolar disorder (BD) face higher risks of death from heart conditions like cardiomyopathy and hypertensive heart disease. Targeted interventions for these conditions are crucial for preventing premature cardiovascular disease (CVD) mortality in BD patients.
Area of Science:
- Cardiovascular epidemiology
- Psychiatric comorbidities
- Public health
Background:
- Bipolar disorder (BD) is associated with a persistent and significant gap in cardiovascular disease (CVD) mortality compared to the general population.
- A limited evidence base on cause-specific CVD mortality in BD hinders the development of targeted preventive strategies.
- Addressing this knowledge gap is essential for reducing premature mortality in individuals with BD.
Purpose of the Study:
- To investigate the specific causes of excess cardiovascular disease (CVD) mortality in individuals diagnosed with bipolar disorder (BD).
- To identify leading causes of both absolute and relative excess CVD mortality within the BD population.
- To inform the development of targeted interventions for CVD prevention in BD.
Main Methods:
- Utilized Finnish nationwide data from 2004-2018 to identify individuals aged 15+ with a BD diagnosis.
- Calculated standardized mortality ratios (SMR) with 95% confidence intervals (CI) by comparing mortality rates in the BD cohort to the general population.
- Followed 53,273 individuals with BD for a total of 428,426 person-years.
Main Results:
- Cardiovascular disease (CVD) accounted for 26% of all deaths (5988 total deaths) in the BD cohort.
- Leading causes of relative excess CVD mortality included cardiomegaly (SMR 4.51), venous thromboembolism (SMR 3.03), cardiomyopathy (SMR 2.46), and hypertensive heart disease (SMR 2.12).
- Coronary artery disease (CAD) was the leading cause of absolute excess CVD mortality (SMR 1.47), with lower relative excess compared to structural/functional heart disorders.
Conclusions:
- Structural and functional heart disorders, particularly cardiomyopathy and hypertensive heart disease, significantly contribute to excess CVD mortality in bipolar disorder (BD), alongside coronary artery disease.
- These findings highlight the importance of addressing modifiable risk factors associated with these conditions.
- Prioritizing interventions targeting cardiomyopathy, hypertensive heart disease, and related factors is crucial for preventing premature CVD mortality in the BD population.
Background:
Limited evidence base on cause-specific excess cardiovascular disease (CVD) mortality in bipolar disorder (BD) is a barrier to developing preventive interventions aimed at reducing the persistent mortality gap in BD.
Objective:
To investigate cause-specific CVD mortality in BD.
Methods:
We identified all individuals aged 15+ years during 2004-2018 with a diagnosis of BD using Finnish nationwide routine data. Standardised mortality ratios (SMR) with 95% confidence intervals (CI) were calculated using the mortality rates in the general population as weights.
Results:
53,273 individuals with BD (57% women; median age at BD diagnosis, 40 years), were followed up for 428,426 person-years (median, 8.2 years). There were 5988 deaths due to any cause, of which 26% were due to CVD. The leading cause of absolute excess CVD mortality was coronary artery disease (CAD). The leading causes of relative excess mortality were cardiomegaly (SMR, 4.51; 95% CI, 3.58-5.43), venous thromboembolism (3.03; 2.26-3.81), cardiomyopathy (2.46; 1.95-2.97), and hypertensive heart disease (2.12; 1.71-2.54). The leading causes of absolute CVD mortality showed markedly lower relative excess, including CAD (1.47; 1.34-1.61), ischaemic stroke (1.31; 1.06-1.54), and acute myocardial infarction (1.12; 0.98-1.25). Due to the higher relative excess mortality, structural and functional heart disorders contributed as much as atherosclerotic and ischaemic disorders to the absolute excess mortality.
Conclusions:
Cardiomyopathy and hypertensive heart disease as the leading causes of relative excess mortality emphasise the contribution of structural and functional heart disorders to the overall excess mortality alongside coronary artery disease. Interventions targeted at these modifiable causes of death should be priorities in the prevention of premature excess CVD mortality in BD.
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