Association of Bipolar Disorder with Major Adverse Cardiovascular Events: A Population-Based Historical Cohort Study

Moein Foroughi, Jose R.Medina Inojosa, Francisco Lopez-Jimenez, Farzane Saeidifard, Laura Suarez, Gorazd B. Stokin, Miguel L. Prieto, Walter A. Rocca, Mark A. Frye, Robert J. Morgan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: This study aimed to assess the association of bipolar disorder (BD) with risk of major adverse cardiac events (MACEs) after adjusting for established cardiovascular disease (CVD) risk factors. Methods: We conducted a population-based historical cohort study using the Rochester Epidemiology Project. Patients older than 30 years with a clinical encounter from 1998 to 2000 with no prior MACE, atrial fibrillation, or heart failure were followed up through March 1, 2016. BD diagnosis was validated by chart review. Cox proportional hazards regression models were adjusted for established CVD risk factors, alcohol use disorder, other substance use disorders (SUDs), and major depressive disorder (MDD). Results: The cohort included 288 individuals with BD (0.81%) and 35, 326 individuals without BD as the reference group (Ref ). Median (interquartile range) follow-up was 16.5 (14.6-17.5) years. A total of 5636MACE events occurred (BD, 59; Ref, 5577). Survival analysis showed an association between BD and MACE (median event-free-survival rates: BD, 0.80; Ref, 0.86; log-rank p = .018). Multivariate regression adjusting for age and sex also yielded an association between BD and MACE (hazard ratio [HR] = 1.93; 95% confidence interval [CI] = 1.43-2.52; p < .001). The association remained significant after further adjusting for smoking, diabetes mellitus, hypertension, high-density lipoprotein cholesterol, and body mass index (HR = 1.66; 95% CI = 1.17-2.28; p = .006), and for alcohol use disorder, SUD, and MDD (HR = 1.56; 95% CI = 1.09-2.14; p = .010). Conclusions: In this study, BD was associated with an increased risk of MACE, which persisted after adjusting for established CVD risk factors, SUDs, and MDD. These results suggest that BD is an independent risk factor for major clinical cardiac disease outcomes.

Original languageEnglish
Pages (from-to)97-103
Number of pages7
JournalPsychosomatic Medicine
Volume84
Issue number1
DOIs
StatePublished - 1 Jan 2022

Bibliographical note

Funding Information:
This work was supported in part by the European Regional Development Fund- Project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868); by resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging under award R01AG034676; by grant CONICYT PFCHA/MAGISTER BECAS CHILE/2012-73130844; and by funding from the Mayo Clinic Center for Individualized Medicine. M.L.P. has received grant support from CONICYT/ANID FONDECYT Regular 1181365 and CONICYT/ANID FONDEF ID19I10116. M.A.F. reports the following conflicts of interest: grant support from Assurex Health, Mayo Foundation, and Medibio; consultancy (Mayo) from Actify Neurotherapies, Allergan, Intra- Cellular Therapies, Inc., Janssen, Myriad, Neuralstem Inc., Sanofi, Takeda, and Teva Pharmaceuticals; CME/travel/honoraria from American Physician Institute, CME Outfitters, Global Academy for Medical Education; and no financial interest/stock ownership/ royalties. All other authors declare no conflicts of interest.

Funding Information:
Source of Funding and Conflicts of Interest: This work was supported in part by the European Regional Development Fund–Project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868); by resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging under award R01AG034676; by grant CONICYT PFCHA/MAGISTER BECAS CHILE/2012-73130844; and by funding from the Mayo Clinic Center for Individualized Medicine.

Funding Information:
M.L.P. has received grant support from CONICYT/ANID FONDECYT Regular 1181365 and CONICYT/ANID FONDEF ID19I10116. M.A.F. reports the following conflicts of interest: grant support from Assurex Health, Mayo Foundation, and Medibio; consultancy (Mayo) from Actify Neurotherapies, Allergan, Intra-Cellular Therapies, Inc., Janssen, Myriad, Neuralstem Inc., Sanofi, Takeda, and Teva Pharmaceuticals; CME/travel/honoraria from American Physician Institute, CME Outfitters, Global Academy for Medical Education; and no financial interest/stock ownership/royalties. All other authors declare no conflicts of interest.

Publisher Copyright:
Copyright © 2021 by the American Psychosomatic Society.

Keywords

  • Bipolar disorder
  • Cardiovascular disease
  • Cohort
  • Major adverse cardiovascular outcomes

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