Lithium in cardiovascular health and disease: Pharmacological and clinical implications

Area of Science:

• Cardiology
• Psychiatry
• Pharmacology

Background:

• Lithium is a primary treatment for bipolar disorder (BD).
• Its cardiovascular effects are complex and not fully understood.
• Evidence suggests both beneficial and detrimental impacts.

Purpose of the Study:

• To review the direct and indirect cardiovascular effects of lithium.
• To synthesize current evidence on lithium's impact on cardiac health.
• To clarify the balance between lithium's therapeutic and adverse cardiovascular effects.

Main Methods:

• Systematic review of existing literature.
• Analysis of direct cardiac effects (development, hypertrophy, fibrosis, mitochondria, arrhythmia).
• Evaluation of indirect effects via renal function, metabolic syndrome, and neuroendocrine-immune pathways.

Main Results:

• Therapeutic lithium doses may offer cardioprotection by inhibiting GSK-3β and modulating Wnt/β-catenin signaling.
• Supratherapeutic lithium levels can increase oxidative stress, mitochondrial dysfunction, and arrhythmogenicity.
• Clinical studies indicate reduced cardiovascular mortality in lithium-treated BD patients, potentially outweighing metabolic side effects.

Conclusions:

• Lithium's cardiovascular impact is dose-dependent and multifaceted.
• Conflicting evidence exists regarding long-term outcomes and dose specificity.
• Further high-quality trials are needed to optimize lithium's safe and effective use in BD treatment.