Objectives: The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular-bipolar link remains underrecognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. Methods: An international group of experts completed a selective review of the literature, distilling core themes, identifying limitations and gaps in the literature, and highlighting future directions to bridge these gaps. Results: The association between bipolar disorder and vascular disease is large in magnitude, consistent across studies, and independent of confounding variables where assessed. The vascular-bipolar link is multifactorial and is difficult to study given the latency between the onset of bipolar disorder, often in adolescence or early adulthood, and subsequent vascular disease, which usually occurs decades later. As a result, studies have often focused on risk factors for vascular disease or intermediate phenotypes, such as structural and functional vascular imaging measures. There is interest in identifying the most relevant mediators of this relationship, including lifestyle (eg, smoking, diet, exercise), medications, and systemic biological mediators (eg, inflammation). Nonetheless, there is a paucity of treatment studies that deliberately engage these mediators, and thus far no treatment studies have focused on engaging vascular imaging targets. Conclusions: Further research focused on the vascular-bipolar link holds promise for gleaning insights regarding the underlying causes of bipolar disorder, identifying novel treatment approaches, and mitigating disparities in cardiovascular outcomes for people with bipolar disorder.
Bibliographical noteFunding Information:
Dr Bond reports honoraria and/or grant funding from Alkermes, Myriad Genetics, the University of Minnesota Foundation, and the University of Minnesota Department of Psychiatry and Behavioral Science. Dr Fiedorowicz has received funding (grants and consultation) from Myriad Genetics, Inc, and grants from National Institute of Mental Health, National Center for Advancing Translational Science and the National Heart, Lung, and Blood Institute. Dr Goldstein reports grant funding from Brain & Behavior Research Foundation, Brain Canada, Canadian Institutes of Health Research, Heart & Stroke Foundation, National Institute of Mental Health, Ontario Mental Health Foundation, Ontario Ministry of Research and Innovation, University of Toronto Department of Psychiatry. Dr Gomes reports speaker honoraria from Abbott, Apsen, Daiichi‐Sankyo, Libbs, and Lundbeck. Dr Hajek reports funding from the Canadian Institutes of Health Research (103703, 106469, and 142255), Brain & Behavior Research Foundation, and the Czech Republic Ministry of Health. Dr McElroy reports having been a consultant to or member of the scientific advisory boards of Allergan, Avanir, Bracket, F. Hoffmann‐La Roche Ltd., Idorsia, Mitsubishi Tanabe Pharma America, Myriad, Opiant, SipNose, Sunovion, and Takeda. She has been a principal or co‐investigator on studies sponsored by Allergan, Avanir, Brainsway, Marriott Foundation, Medibio, Myriad, Neurocrine, Novo Nordisk, Otsuka, and Sunovion. She is also an inventor on United States Patent No. 6 323 236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patent's assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. Dr McIntyre reports fees from Takeda, Janssen, Allergan, Otsuka, Shire, Lundbeck, Pfizer, Minerva, Neurocrine, BaushHealth, and NovoNordisk. Dr Prieto has received grant funding from CONICYT of the Government of Chile (grant FONDECYT 1181365 and grant FONDEF ID19I10116). Dr Sylvia reports personal fees from United Biosource Corporation, Clintara, Bracket, and Clinical Trials Network and Institute; royalty fees from New Harbinger; grants from National Institute of Mental Health, Patient Centered Outcomes Research Institute, American Foundation for Suicide Prevention, and Takeda. The other authors do not have any financial disclosures to report.
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
- bipolar disorder
- cardiovascular disease