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Neurobiological Mechanisms Link Bipolar Disorder to Cardiovascular Disease: A Retrospective Biobank Study of Adverse

Ji Hyun Baek1,2, Simran S Grewal3,4, Krystel Abi Karam3

  • 1Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, Massachusetts, USA.

Bipolar Disorders
|January 31, 2025
PubMed

Insights

Individuals with bipolar disorder face higher cardiovascular disease risk. Neurobiological, autonomic, and inflammatory pathways significantly contribute to this increased risk, highlighting potential mechanisms for intervention.

Area of Science:

  • Cardiovascular Medicine
  • Psychiatry
  • Neuroscience

Background:

  • Bipolar disorder (BD) is linked to increased cardiovascular disease (CVD) risk.
  • The underlying mechanisms connecting BD and CVD remain unclear.
  • Understanding these links is crucial for patient care and risk mitigation.

Purpose of the Study:

  • To quantify the risk of major adverse cardiovascular events (MACE) in individuals with BD, adjusting for confounders.
  • To investigate neural, autonomic, and immune system pathways as potential mediators of the BD-CVD association.

Main Methods:

  • Utilized the Mass General Brigham Biobank, identifying BD and MACE using ICD codes.
  • Analyzed incident MACE over a 10-year period and incorporated health behavior data from surveys.
  • Employed Cox regression hazard models to assess risk and mediation.

Main Results:

  • A cohort of 118,827 participants included 6009 with BD.
  • BD was associated with a 29% increased MACE risk (HR 1.29 [1.10-1.51]), persisting after adjusting for risk factors and lifestyle behaviors.
  • Sympathetic nervous activity (SNA), autonomic nervous system (ANS) markers, and inflammation significantly mediated the BD-MACE relationship (3.8%-17.8% contribution).

Conclusions:

  • Bipolar disorder is independently associated with elevated cardiovascular risk.
  • Neurobiological, autonomic, and inflammatory pathways are implicated in mediating CVD risk in BD patients.
  • These findings suggest novel therapeutic targets for reducing cardiovascular morbidity in bipolar disorder.
Abstract

Keywords:
bipolar disordercardiovascular diseaseheart rate variabilityinflammationstress‐related neural network activity

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