Incidence of heart disease and stroke among patients with bipolar disorder

Abstract

Background Increased vulnerability to cardiovascular diseases (CVD) and stroke has been observed among people with mental disorders, such as bipolar disorder (BP). Yet, the evidence for the association between severe mental disorders and CVD and stroke events remains inconclusive. Purpose By running a cohort study based on large retrospective data, we aimed to establish the relative risk of CVD problems and stroke in patients admitted to the hospital and diagnosed with BP. Methods The study was conducted on electronic health records provided by 113 healthcare organizations worldwide from the TriNetX Global Collaborative Network, containing at least 690,946 patients with BP symptoms. The assessment was focused on the first incidence of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction among patients after BP diagnosis. After propensity score matching age, gender, race and comorbidities, the rates were compared against a cohort of patients with no mental, behavioral, or neurodevelopmental disorders who also suffered from similar CVD and stroke events. In addition, Kaplan-Meier Analysis was performed to compare their survivability to CVD, taking into account patient censoring. Results Patient count after applying the score matching yielded 532,082 per cohort. The odds ratio (OR) of ischemic heart diseases, nontraumatic brain hemorrhage, or cerebral infarction on BP compared to people without any mental disorder was equal to 2.349, indicating a significantly elevated risk for such events. The Kaplan-Meier analysis showed that patients with BP diagnosis had 9.88% less survival probability to having CVD problems after 20 years since the diagnosis than patients without any mental disorder. With a hazard ratio of 1.970 (95%CI 1.935-2.005), the risk of developing a CVD problem on the former (patients with BP diagnosis) was almost twice greater than for patients suffering without mental health disorders. Conclusion There is an increased risk of developing cardiovascular problems and stroke among patients with bipolar disorder compared to patients affected by such symptoms without mental disorders. The robust results were ensured by limiting the potential confounders with the propensity score matching procedure, such as demographics, comorbidity, and medication. The study implies that monitoring and prevention approaches for cardiovascular and cerebral vascular diseases must be tailored to symptoms of mental disorders.