Neurobiological Mechanisms Link Bipolar Disorder to Cardiovascular Disease: A Retrospective Biobank Study of Adverse Event Risk and Contributory Mechanisms

IF 5 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2025-01-30 DOI:10.1111/bdi.13516

Ji Hyun Baek, Simran S. Grewal, Krystel Abi Karam, Erin R. Hanlon, Shady Abohashem, Antonia V. Seligowski, Michael Henry, Michael T. Osborne, Andrew A. Nierenberg, Ahmed Tawakol

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引用次数: 0

Abstract

Objective

Individuals with bipolar disorder are at greater risk of developing cardiovascular disease. However, the mechanisms underlying this association remain poorly understood. This study aimed to (1) determine the risk of major adverse cardiovascular events (MACE) after adjusting for important confounders and (2) evaluate the neural, autonomic, and immune mechanisms underlying the link between bipolar disorder and cardiovascular disease.

Methods

Leveraging the Mass General Brigham Biobank, bipolar disorder and incident MACE were identified using the International Classification of Disease (ICD) codes. Incident MACE events were assessed from enrollment to the date of data lock (December 2020); or to the 10-year period. Health behavior data were derived from optional surveys. Cox regression hazard models were applied.

Results

Of 118,827 Biobank participants, 6009 were diagnosed with bipolar disorder. Those with bipolar disorder (vs. without) demonstrated a higher risk of MACE after adjusting for cardiovascular risk factors (hazard ratio [95% confidence interval] = 1.29 [1.10–1.51], p = 0.002). The relationship remained significant over 10 years after adjustment for unhealthy lifestyle behaviors (1.29 [1.03, 1.61], p = 0.025). Furthermore, SNA, autonomic nervous system, and inflammatory markers each significantly associated with both bipolar disorder and MACE risk. Each of these measures mediated the association between bipolar disorder and MACE (accounting for 3.8%–17.8% of the relationship).

Conclusion

This study demonstrates that bipolar disorder associates with heightened cardiovascular risk, even after accounting for cardiovascular risk. Moreover, the findings suggest that neurobiological pathways and perturbations in autonomic and inflammatory pathways may confer cardiovascular risk in bipolar disorder.

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神经生物学机制将双相情感障碍与心血管疾病联系起来：不良事件风险和促成机制的回顾性生物库研究。

目的：双相情感障碍患者患心血管疾病的风险更高。然而，这种关联背后的机制仍然知之甚少。本研究旨在(1)在调整重要混杂因素后确定主要不良心血管事件（MACE）的风险；(2)评估双相情感障碍与心血管疾病之间联系的神经、自主神经和免疫机制。方法：利用麻省总医院布里格姆生物银行，使用国际疾病分类（ICD）代码识别双相情感障碍和事件性MACE。从入组到数据锁定日期（2020年12月）评估事件MACE事件；或者是10年。健康行为数据来源于选择性调查。采用Cox回归风险模型。结果：在118,827名生物银行参与者中，6009人被诊断为双相情感障碍。在调整心血管危险因素后，双相情感障碍患者（与非双相情感障碍患者相比）发生MACE的风险更高（风险比[95%置信区间]= 1.29 [1.10-1.51],p = 0.002）。在调整不健康生活方式后的10年内，两者之间的关系仍然显著（1.29 [1.03,1.61],p = 0.025）。此外，SNA、自主神经系统和炎症标志物均与双相情感障碍和MACE风险显著相关。每一项测量都介导了双相情感障碍和MACE之间的关联（占关系的3.8%-17.8%）。结论：本研究表明，即使考虑到心血管风险，双相情感障碍也与心血管风险增加有关。此外，研究结果表明，神经生物学途径和自主神经和炎症途径的扰动可能会增加双相情感障碍的心血管风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.