Body mass index and blood pressure in bipolar patients: Target cardiometabolic markers for clinical practice

Alfredo B. Cuellar-Barboza, Alejandra Cabello-Arreola, Stacey J. Winham, Colin Colby, Francisco Romo-Nava, Nicolas A. Nunez, Robert J. Morgan, Ruchi Gupta, Joshua T. Bublitz, Miguel L. Prieto, Elena A. De Filippis, Francisco Lopez-Jimenez, Susan L. McElroy, Joanna M. Biernacka, Mark A. Frye, Marin Veldic*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: To evaluate the association between cardiometabolic markers and bipolar disorder (BD), examining the impact of sex and cardiometabolic medication use, from a large case-control biorepository of more than 1300 participants. Patients and Methods: Recruited from July 2009 through September 2017, cardiometabolic markers were harvested from electronic health records (EHR) of participants (n=661) from the Mayo Clinic Individualized Medicine Biobank for Bipolar Disorder and Mayo Clinic Biobank age-sex-matched controls (n=706). Markers were compared between cases and controls using logistic regression, stratified by sex, adjusting for cardiometabolic medications and current smoking status. We studied the effect of psychotropics in case-only analyses. Results: The mean age of the sample was 52.5 ± 11.6 years and 55% were female. BD patients had higher rates of smoking, but lower utilization of lipid-lowering medication compared with controls. After adjustment, BD was associated with obesity [Odds ratio (CI) 1.62 (1.22-2.15)], elevated systolic blood pressure (SBP) [2.18 (1.55-3.06)] and elevated triglycerides [1.58 (1.13-2.2)]. When stratified by sex, obesity [1.8 (1.23-2.66)] and systolic blood pressure [2.32 (1.46-3.7)] were associated with BD females compared to female controls; however, only systolic blood pressure [2.04 (1.23-3.42)] was associated with male bipolars compared to male controls. Psychotropics were marginally associated with mean BMI, abnormal triglycerides, and HbA1c. Limitations: EHR cross-sectional data Conclusion: To our knowledge, this is the largest case controlled study to date to explore the association between cardiometabolic markers and bipolar disorder adjusting for utilization of cardiometabolic medication. Identification of significant, non-laboratory based cardiometabolic markers that are associated with increased risk of major cardiovascular adverse events in patients with bipolar disorder, underscores, both the utility and importance of risk monitoring that can be easily done in community mental health centers.

Original languageEnglish
Pages (from-to)637-643
Number of pages7
JournalJournal of Affective Disorders
StatePublished - 1 Mar 2021
Externally publishedYes

Bibliographical note

Funding Information:
Funding for this study was provided by the Marriott Foundation. The foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funding Information:
Dr. Mark Frye has received grant support from Assurex Health, Inc., the Mayo Foundation for Medical Education and Research, and Medibio, Ltd.; has served as a paid consultant for Actify Neurotherapies, Allergan plc, IntraCellular Therapies, Inc., Janssen Pharmaceuticals, Inc., Myriad Genetics, Inc., Neuralstem, Inc., Takeda Pharmaceutical Company, Ltd., and Teva Pharmaceutical Industries, Ltd.; and has received honoraria or travel support from American Physician Institute, CME Outfitters, LLC, and Global Academy for Medical Education.

Funding Information:
Dr. Francisco Romo-Nava receives grant support from the National Institute of Mental Health K23 Award (K23MH120503) and from a 2017 NARSAD Young Investigator Award from the Brain and Behavior Research Foundation; has a USPTO # 20190134386 patent pending; and has received non-financial research support from Soterix Medical.

Funding Information:
This study was supported, in part, by the Marriott Family Foundation and the Mayo Clinic Center for Individualized Medicine.

Publisher Copyright:
© 2020

Copyright 2021 Elsevier B.V., All rights reserved.


  • Bipolar disorder
  • Cardiometabolic markers
  • High blood pressure
  • Obesity
  • Triglycerides


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