Cardiovascular disease grave in patients with bipolar disorder

By Eleanor McDermid, Senior medwireNews Reporter

Cardiovascular disease (CVD) has a particularly large impact on life expectancy if patients also have bipolar disorder, say researchers.

Patients with CVD and bipolar disorder die around 10 years earlier than those with CVD in the general population, report Jeanette Westman (Karolinska Institutet, Stockholm, Sweden) and team in BMJ Open.

However, hospital admission rates for CVD and cerebrovascular disease were increased just 1.30- and 1.39-fold, respectively, among patients with bipolar disorder relative to the general population, despite their twofold increased risk for dying from these conditions.

Together with the increased prevalence of CVD previously reported in patients with bipolar disorder, this finding "strongly suggests that CVD is undertreated in bipolar patients when compared to the general population," say Westman et al.

They note that healthcare in Sweden is free at the point of use, so financial constraints among psychiatric patients do not account for undertreatment of CVD. "Our results indicate a failure of the healthcare system to identify and address the health needs of those patients, which has also been shown in other studies of people with severe mental disorders."

The register-based study covered all 10.6 million residents of Sweden, and included 17,101 patients who were diagnosed with bipolar disorder between 1987 and 2006. The rate of suicide and other external causes of death, such as homicide and accident, was elevated 9.7-fold among bipolar patients; however, this only accounted for 18% of deaths, whereas CVD accounted for 38% and other somatic causes for 44%.

CVD and other somatic causes of death were elevated more than twofold among bipolar patients, and accounted for 824 and 988 excess deaths, respectively, over the study period, while suicide and other external causes accounted for 675 excess deaths.

The increased CVD mortality risk among bipolar disorder patients was seen for coronary heart disease, acute myocardial infarction, and cerebrovascular disease, with patients dying significantly younger of these conditions if they had bipolar disorder than if they did not.

The team concludes that "effective cardiac treatment would ensure longevity and improved quality of life for patients with bipolar disorder."

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