Long-term risk of myocardial infarction and stroke in bipolar i disorder: A population-based Cohort Study

Miguel L. Prieto; Louis A. Schenck; Jennifer L. Kruse; James P. Klaas; Alanna M. Chamberlain; William V. Bobo; Frank Bellivier; Marion Leboyer; Véronique L. Roger; Robert D. Brown; Walter A. Rocca; Mark A. Frye

doi:10.1016/j.jad.2016.01.015

Long-term risk of myocardial infarction and stroke in bipolar i disorder: A population-based Cohort Study

Miguel L. Prieto, Louis A. Schenck, Jennifer L. Kruse, James P. Klaas, Alanna M. Chamberlain, William V. Bobo, Frank Bellivier, Marion Leboyer, Véronique L. Roger, Robert D. Brown, Walter A. Rocca, Mark A. Frye^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Objectives To estimate the risk of fatal and non-fatal myocardial infarction (MI) and stroke in patients with bipolar I disorder compared to people without bipolar I disorder. Method Utilizing a records-linkage system spanning 30 years (1966-1996), a population-based cohort of 334 subjects with bipolar I disorder and 334 age and sex-matched referents from Olmsted County, Minnesota, U.S. was identified. Longitudinal follow-up continued until incident MI or stroke (confirmed by board-certified cardiologist/neurologist), death, or study end date (December 31, 2013). Cox proportional hazards models assessed the hazard ratio (HR) for MI or stroke, adjusting for potential confounders. Results There was an increased risk of fatal or non-fatal MI or stroke (as a composite outcome) in patients with bipolar I disorder [HR 1.54, 95% confidence interval (CI) 1.02, 2.33; p=0.04]. However, after adjusting for baseline cardiovascular risk factors (alcoholism, hypertension, diabetes, and smoking), the risk was no longer significantly increased (HR 1.19, 95% CI 0.76, 1.86; p=0.46). Limitations Small sample size for the study design. Findings were not retained after adjustment for cardiovascular disease risk factors. Psychotropic medication use during the follow-up was not ascertained and was not included in the analyses. Conclusion This study in a geographically defined region in the U.S. demonstrated a significant increased risk of MI or stroke in bipolar I disorder, which was no longer significant after adjustment for cardiovascular risk factors.

Original language	English
Pages (from-to)	120-127
Number of pages	8
Journal	Journal of Affective Disorders
Volume	194
DOIs	https://doi.org/10.1016/j.jad.2016.01.015
State	Published - 1 Apr 2016

Bibliographical note

Funding Information:
This project was made possible by the Rochester Epidemiology Project (Grant number R01-AG034676 ; from the National Institute on Aging [NIA]). It was partially supported by Grant UL1-TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. It was partially supported by Mayo Foundation for Medical Education and Research , the Marriott Foundation and the Government of Chile (CONICYT Becas Chile Grant number 73130844) .

Funding Information:
Dr. Frye has been a consultant (unpaid) for Allergan, Merck, Myriad, Sanofi-Aventis, Sunovion, Takeda Global Research, Teva Pharmaceuticals, United Biosource Corporation, has received grant support from Myriad, Pfizer, National Alliance for Schizophrenia and Depression (NARSAD), National Institute of Mental Health (NIMH), National Institute of Alcohol Abuse and Alcoholism (NIAAA), Mayo Foundation, and has received travel support from the Chilean Society of Neurology, Psychiatry and Neurosurgery (Sociedad de Neurologia, Psiquiatria y Neurocirugia), Advanced Health Media, GlaxoSmithKline, Colombian Society of Neuropsychopharmacology, AstraZeneca, Bristol-Myers-Squib, Otsuka, Sanofi-Aventis.

Funding Information:
We thank Merle J. Belz, RN, Cynthia L. Nosek, RN, and Cynthia J. Stoppel, BS for their work abstracting the medical records, Jennifer St. Sauver, PhD for her advice on the Rochester Epidemiology Project, and Renato D. Alarcón, MD, MPH, Timothy W. Lineberry, MD, and Glenn E. Smith, PhD for their advice and support to this project.

Publisher Copyright:
© 2016 Published by Elsevier B.V.

Keywords

Bipolar disorder
Cardiovascular diseases
Cohort studies
Risk

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jad.2016.01.015

Cite this

Prieto, M. L., Schenck, L. A., Kruse, J. L., Klaas, J. P., Chamberlain, A. M., Bobo, W. V., Bellivier, F., Leboyer, M., Roger, V. L., Brown, R. D., Rocca, W. A., & Frye, M. A. (2016). Long-term risk of myocardial infarction and stroke in bipolar i disorder: A population-based Cohort Study. Journal of Affective Disorders, 194, 120-127. https://doi.org/10.1016/j.jad.2016.01.015

@article{18b180b395aa4d77988b5732ff540ca4,

title = "Long-term risk of myocardial infarction and stroke in bipolar i disorder: A population-based Cohort Study",

abstract = "Objectives To estimate the risk of fatal and non-fatal myocardial infarction (MI) and stroke in patients with bipolar I disorder compared to people without bipolar I disorder. Method Utilizing a records-linkage system spanning 30 years (1966-1996), a population-based cohort of 334 subjects with bipolar I disorder and 334 age and sex-matched referents from Olmsted County, Minnesota, U.S. was identified. Longitudinal follow-up continued until incident MI or stroke (confirmed by board-certified cardiologist/neurologist), death, or study end date (December 31, 2013). Cox proportional hazards models assessed the hazard ratio (HR) for MI or stroke, adjusting for potential confounders. Results There was an increased risk of fatal or non-fatal MI or stroke (as a composite outcome) in patients with bipolar I disorder [HR 1.54, 95% confidence interval (CI) 1.02, 2.33; p=0.04]. However, after adjusting for baseline cardiovascular risk factors (alcoholism, hypertension, diabetes, and smoking), the risk was no longer significantly increased (HR 1.19, 95% CI 0.76, 1.86; p=0.46). Limitations Small sample size for the study design. Findings were not retained after adjustment for cardiovascular disease risk factors. Psychotropic medication use during the follow-up was not ascertained and was not included in the analyses. Conclusion This study in a geographically defined region in the U.S. demonstrated a significant increased risk of MI or stroke in bipolar I disorder, which was no longer significant after adjustment for cardiovascular risk factors.",

keywords = "Bipolar disorder, Cardiovascular diseases, Cohort studies, Risk, Bipolar disorder, Cardiovascular diseases, Cohort studies, Risk",

author = "Prieto, {Miguel L.} and Schenck, {Louis A.} and Kruse, {Jennifer L.} and Klaas, {James P.} and Chamberlain, {Alanna M.} and Bobo, {William V.} and Frank Bellivier and Marion Leboyer and Roger, {V{\'e}ronique L.} and Brown, {Robert D.} and Rocca, {Walter A.} and Frye, {Mark A.}",

note = "Funding Information: This project was made possible by the Rochester Epidemiology Project (Grant number R01-AG034676 ; from the National Institute on Aging [NIA]). It was partially supported by Grant UL1-TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. It was partially supported by Mayo Foundation for Medical Education and Research , the Marriott Foundation and the Government of Chile (CONICYT Becas Chile Grant number 73130844) . Funding Information: Dr. Frye has been a consultant (unpaid) for Allergan, Merck, Myriad, Sanofi-Aventis, Sunovion, Takeda Global Research, Teva Pharmaceuticals, United Biosource Corporation, has received grant support from Myriad, Pfizer, National Alliance for Schizophrenia and Depression (NARSAD), National Institute of Mental Health (NIMH), National Institute of Alcohol Abuse and Alcoholism (NIAAA), Mayo Foundation, and has received travel support from the Chilean Society of Neurology, Psychiatry and Neurosurgery (Sociedad de Neurologia, Psiquiatria y Neurocirugia), Advanced Health Media, GlaxoSmithKline, Colombian Society of Neuropsychopharmacology, AstraZeneca, Bristol-Myers-Squib, Otsuka, Sanofi-Aventis. Funding Information: We thank Merle J. Belz, RN, Cynthia L. Nosek, RN, and Cynthia J. Stoppel, BS for their work abstracting the medical records, Jennifer St. Sauver, PhD for her advice on the Rochester Epidemiology Project, and Renato D. Alarc{\'o}n, MD, MPH, Timothy W. Lineberry, MD, and Glenn E. Smith, PhD for their advice and support to this project. Publisher Copyright: {\textcopyright} 2016 Published by Elsevier B.V.",

year = "2016",

month = apr,

day = "1",

doi = "10.1016/j.jad.2016.01.015",

language = "English",

volume = "194",

pages = "120--127",

journal = "Journal of Affective Disorders",

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T1 - Long-term risk of myocardial infarction and stroke in bipolar i disorder

T2 - A population-based Cohort Study

AU - Prieto, Miguel L.

AU - Schenck, Louis A.

AU - Kruse, Jennifer L.

AU - Klaas, James P.

AU - Chamberlain, Alanna M.

AU - Bobo, William V.

AU - Bellivier, Frank

AU - Leboyer, Marion

AU - Roger, Véronique L.

AU - Brown, Robert D.

AU - Rocca, Walter A.

AU - Frye, Mark A.

N1 - Funding Information: This project was made possible by the Rochester Epidemiology Project (Grant number R01-AG034676 ; from the National Institute on Aging [NIA]). It was partially supported by Grant UL1-TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. It was partially supported by Mayo Foundation for Medical Education and Research , the Marriott Foundation and the Government of Chile (CONICYT Becas Chile Grant number 73130844) . Funding Information: Dr. Frye has been a consultant (unpaid) for Allergan, Merck, Myriad, Sanofi-Aventis, Sunovion, Takeda Global Research, Teva Pharmaceuticals, United Biosource Corporation, has received grant support from Myriad, Pfizer, National Alliance for Schizophrenia and Depression (NARSAD), National Institute of Mental Health (NIMH), National Institute of Alcohol Abuse and Alcoholism (NIAAA), Mayo Foundation, and has received travel support from the Chilean Society of Neurology, Psychiatry and Neurosurgery (Sociedad de Neurologia, Psiquiatria y Neurocirugia), Advanced Health Media, GlaxoSmithKline, Colombian Society of Neuropsychopharmacology, AstraZeneca, Bristol-Myers-Squib, Otsuka, Sanofi-Aventis. Funding Information: We thank Merle J. Belz, RN, Cynthia L. Nosek, RN, and Cynthia J. Stoppel, BS for their work abstracting the medical records, Jennifer St. Sauver, PhD for her advice on the Rochester Epidemiology Project, and Renato D. Alarcón, MD, MPH, Timothy W. Lineberry, MD, and Glenn E. Smith, PhD for their advice and support to this project. Publisher Copyright: © 2016 Published by Elsevier B.V.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objectives To estimate the risk of fatal and non-fatal myocardial infarction (MI) and stroke in patients with bipolar I disorder compared to people without bipolar I disorder. Method Utilizing a records-linkage system spanning 30 years (1966-1996), a population-based cohort of 334 subjects with bipolar I disorder and 334 age and sex-matched referents from Olmsted County, Minnesota, U.S. was identified. Longitudinal follow-up continued until incident MI or stroke (confirmed by board-certified cardiologist/neurologist), death, or study end date (December 31, 2013). Cox proportional hazards models assessed the hazard ratio (HR) for MI or stroke, adjusting for potential confounders. Results There was an increased risk of fatal or non-fatal MI or stroke (as a composite outcome) in patients with bipolar I disorder [HR 1.54, 95% confidence interval (CI) 1.02, 2.33; p=0.04]. However, after adjusting for baseline cardiovascular risk factors (alcoholism, hypertension, diabetes, and smoking), the risk was no longer significantly increased (HR 1.19, 95% CI 0.76, 1.86; p=0.46). Limitations Small sample size for the study design. Findings were not retained after adjustment for cardiovascular disease risk factors. Psychotropic medication use during the follow-up was not ascertained and was not included in the analyses. Conclusion This study in a geographically defined region in the U.S. demonstrated a significant increased risk of MI or stroke in bipolar I disorder, which was no longer significant after adjustment for cardiovascular risk factors.

AB - Objectives To estimate the risk of fatal and non-fatal myocardial infarction (MI) and stroke in patients with bipolar I disorder compared to people without bipolar I disorder. Method Utilizing a records-linkage system spanning 30 years (1966-1996), a population-based cohort of 334 subjects with bipolar I disorder and 334 age and sex-matched referents from Olmsted County, Minnesota, U.S. was identified. Longitudinal follow-up continued until incident MI or stroke (confirmed by board-certified cardiologist/neurologist), death, or study end date (December 31, 2013). Cox proportional hazards models assessed the hazard ratio (HR) for MI or stroke, adjusting for potential confounders. Results There was an increased risk of fatal or non-fatal MI or stroke (as a composite outcome) in patients with bipolar I disorder [HR 1.54, 95% confidence interval (CI) 1.02, 2.33; p=0.04]. However, after adjusting for baseline cardiovascular risk factors (alcoholism, hypertension, diabetes, and smoking), the risk was no longer significantly increased (HR 1.19, 95% CI 0.76, 1.86; p=0.46). Limitations Small sample size for the study design. Findings were not retained after adjustment for cardiovascular disease risk factors. Psychotropic medication use during the follow-up was not ascertained and was not included in the analyses. Conclusion This study in a geographically defined region in the U.S. demonstrated a significant increased risk of MI or stroke in bipolar I disorder, which was no longer significant after adjustment for cardiovascular risk factors.

KW - Bipolar disorder

KW - Cardiovascular diseases

KW - Cohort studies

KW - Risk

KW - Bipolar disorder

KW - Cardiovascular diseases

KW - Cohort studies

KW - Risk

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SN - 0165-0327

VL - 194

SP - 120

EP - 127

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

Long-term risk of myocardial infarction and stroke in bipolar i disorder: A population-based Cohort Study

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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