Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder

Jess G Fiedorowicz; David A Solomon; Jean Endicott; Andrew C Leon; Chunshan Li; John P Rice; William H Coryell

doi:10.1097/psy.0b013e3181acee26

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Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder

Journal article

Peer reviewed

Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder

Jess G Fiedorowicz, David A Solomon, Jean Endicott, Andrew C Leon, Chunshan Li, John P Rice and William H Coryell

Psychosomatic medicine, Vol.71(6), pp.598-606

07/2009

DOI: 10.1097/psy.0b013e3181acee26

PMCID: PMC2779721

PMID: 19561163

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Abstract

To compare the risk for cardiovascular mortality between bipolar I and bipolar II subtypes and determine correlates of cardiovascular mortality. Bipolar disorder conveys an increased risk of cardiovascular mortality. Participants with major affective disorders were recruited for the National Institute of Mental Health Collaborative Depression Study and followed prospectively for up to 25 years. A total of 435 participants met the diagnostic criteria for bipolar I (n = 288) or bipolar II (n = 147) disorder based on Research Diagnostic Criteria at intake and measures of psychiatric symptoms during follow-up. Diagnostic subtypes were contrasted by cardiovascular mortality risk using Cox proportional hazards regression. Affective symptom burden (the proportion of time with clinically significant manic/hypomanic or depressive symptoms) and treatment exposure were additionally included in the models. Thirty-three participants died from cardiovascular causes. Participants with bipolar I disorder had more than double the cardiovascular mortality risk of those with bipolar II disorder, after controlling for age and gender (hazard ratio = 2.35, 95% Confidence Interval = 1.04-5.33; p = .04). The observed difference in cardiovascular mortality between these subtypes was at least partially confounded by the burden of clinically significant manic/hypomanic symptoms which predicted cardiovascular mortality independent of diagnosis, treatment exposure, age, gender, and cardiovascular risk factors at intake. Selective serotonin uptake inhibitors seemed protective although they were introduced late in follow-up. Depressive symptom burden was not related to cardiovascular mortality. Participants with bipolar I disorder may face a greater risk of cardiovascular mortality than those with bipolar II disorder. This difference in cardiovascular mortality risk may reflect manic/hypomanic symptom burden.

Prospective Studies

Follow-Up Studies

Humans

Risk Factors

Proportional Hazards Models

Cost of Illness

Male

Bipolar Disorder - mortality

Bipolar Disorder - diagnosis

Cause of Death

Bipolar Disorder - classification

Psychiatric Status Rating Scales

Cardiovascular Diseases - mortality

Adult

Female

Longitudinal Studies

Cohort Studies

Details

Title: Subtitle: Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder
Creators: Jess G Fiedorowicz - Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. jess-fiedorowicz@uiowa.edu
David A Solomon
Jean Endicott
Andrew C Leon
Chunshan Li
John P Rice
William H Coryell
Resource Type: Journal article
Publication Details: Psychosomatic medicine, Vol.71(6), pp.598-606
DOI: 10.1097/psy.0b013e3181acee26
PMID: 19561163
PMCID: PMC2779721
NLM abbreviation: Psychosom Med
ISSN: 0033-3174
eISSN: 1534-7796
Publisher: United States
Grant note: 5R01MH025422 / NIMH NIH HHS 5R01MH025427 / NIMH NIH HHS 5R01MH025419 / NIMH NIH HHS 5R01MH029957 / NIMH NIH HHS R01 MH025416 / NIMH NIH HHS R01 MH023864 / NIMH NIH HHS 5R01MH025432 / NIMH NIH HHS 5R01MH025426 / NIMH NIH HHS R01 MH025478 / NIMH NIH HHS 5R01MH025433 / NIMH NIH HHS R01 MH025416-33 / NIMH NIH HHS R01 MH025430 / NIMH NIH HHS 5R01MH025421 / NIMH NIH HHS 5R01MH025424 / NIMH NIH HHS 5R01MH025420 / NIMH NIH HHS L30 MH075180 / NIMH NIH HHS 5R01MH025431 / NIMH NIH HHS 5R01MH025425 / NIMH NIH HHS 5R01MH025416 / NIMH NIH HHS 5R01MH025423 / NIMH NIH HHS L30 MH075180-02 / NIMH NIH HHS 5R01MH025428 / NIMH NIH HHS R01 MH029957 / NIMH NIH HHS 5R01MH025418 / NIMH NIH HHS 5R01MH023864 / NIMH NIH HHS 5R01MH025478 / NIMH NIH HHS 5R01MH025417 / NIMH NIH HHS 5R01MH025430 / NIMH NIH HHS 5R01MH025429 / NIMH NIH HHS
Language: English
Date published: 07/2009
Academic Unit: Psychiatry; Epidemiology; Internal Medicine
Record Identifier: 9984003441902771

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