Stroke warning for bipolar patients

Sep 25 2013

By Eleanor McDermid, Senior medwireNews Reporter

Patients with bipolar disorder are at an increased risk for having a stroke and for dying soon after their stroke, a study shows.

The reason for such an association in bipolar disorder patients is not yet clear, say lead researcher Tieh-Chi Chung (Meiho University, Taiwan) and colleagues. However, there is an established link between depression and stroke, with a direct cerebrovascular mechanism even proposed.

“Many causes, such as unhealthy lifestyle, comorbid medical conditions, and the use of psychotropic medications, could all contribute to the increased risk of stroke among patients with bipolar disorder, which will need further investigation,” writes the team in PLoS One.

The 16,821 bipolar disorder patients in the study, identified from a national database, had significantly more comorbidities than 67,284 age- and gender-matched mentally healthy controls. They had higher Charlson Comorbidity Index scores and were more likely to have diabetes, hypertension, hyperlipidemia, and coronary heart disease. They also had a lower socioeconomic status.

“[C]are-givers should pay more attention to the physical condition of patients with bipolar disorder and give them regular physical and laboratory examinations since these patients can have more difficulty caring for themselves compared to other types of patients,” comment Chung et al.

All study participants were free of stroke at baseline, but between 2004 and 2010, 2.8% of the bipolar disorder patients and 2.1% of the controls had a stroke, equating to a 24% increased risk in bipolar disorder patents after accounting for patient, physician, and hospital variables.

Of those who had a stroke, 32.8% of bipolar disorder patients and 24.8% of controls died before the end of the 7-year follow-up. Accounting for confounders (not including stroke severity) revealed a significant 28% increased mortality risk for bipolar disorder patients with stroke.

Factors associated with the highest mortality risk were being male, age of 65 years or older, living in a rural area, having a Charlson Comorbidity Index score of at least 2, and having hemorrhagic or unspecified rather than ischemic stroke. Mortality risk fell if patients were treated by a physician with a high stroke caseload (at least 85 patients)

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