Cardiovascular disease and hypertension among adults with bipolar I disorder in the United States

Authors

  • Benjamin I Goldstein,

    1. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
    2. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Toronto, ON, Canada
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  • Andrea Fagiolini,

    1. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
    2. Department of Neuroscience, Division of Psychiatry, University of Siena School of Medicine, Siena, Italy
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  • Patricia Houck,

    1. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • David J Kupfer

    1. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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  • BIG has served on an advisory panel to Solvay. AF is/has been a consultant and/or speaker for Bristol-Myers Squibb, Pfizer, Eli Lilly & Co., Novartis and Takeda. PH and DJK have no competing interests to report.

Corresponding author:
Benjamin I. Goldstein, MD, PhD, FRCPC
Department of Psychiatry
Sunnybrook Health Sciences Centre
2079 Bayview Avenue
Toronto, Ontario
M4N-3M5, Canada
Fax: 416-480-6878
E-mail: benjamin.goldstein@sunnybrook.ca

Abstract

Objective:  Despite ample evidence of excess cardiovascular mortality in bipolar disorder (BD), few studies have demonstrated increased prevalence of cardiovascular disease (CVD) and/or hypertension (HTN) in BD. We therefore examined this topic in a representative epidemiologic sample.

Method:  The 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to determine whether prevalence of physician-diagnosed CVD and HTN is elevated among subjects with lifetime bipolar I disorder (BD-I), and whether CVD and HTN are prevalent at earlier ages among subjects with BD-I.

Results:  The age-, race-, and sex-adjusted prevalence of CVD was significantly greater among subjects with BD-I versus controls [odds ratio (OR) = 4.95, 95% confidence interval (CI): 4.27–5.75] and versus subjects with major depressive disorder [(MDD); OR =1.80, 95% CI: 1.52–2.14], as was the prevalence of HTN (OR = 2.38, 95% CI: 2.16–2.62 versus controls, OR = 1.44, 95% CI: 1.30–1.61 versus MDD; p < 0.0001 for all). Controlling additionally for marital status, education, income, obesity, smoking, anxiety disorders, and substance use disorders did not substantially alter these findings. The mean age of BD-I subjects with CVD and HTN was 14 and 13 years younger, respectively, than controls with CVD and HTN.

Conclusions:  Adults with BD-I are at increased risk of CVD and HTN, prevalent over a decade earlier than non-BD adults. Strategies are needed to prevent excessive and premature cardiovascular burden in BD-I.

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