People with a history of manic or hypomanic episodes (MHE) have an increased risk for incident cardiovascular disease (CVD), study findings suggest.

“Recognition of manic symptoms and addressing related CVD risk factors could have long-term preventative implications in the development of CVD in the community,” say Christine Ramsey and colleagues from the Johns Hopkins University in Baltimore, Maryland, USA.

While bipolar disorder has previously been linked to CVD, it has remained unclear whether depression or mania underlies the association.

To investigate, the researchers examined the history of HME as an independent risk factor for CVD during an 11.5-year follow-up of the Baltimore Epidemiologic Catchment Area Follow-up Study.

A total of 58 patients with a history of MHE, 71 with major depressive episodes only, and 1339 with no mood episodes were psychiatrically assessed in 1981 and 1982.

Incident CVD, comprising myocardial infarction or congestive heart failure, was self-reported in 1993??”1996 by 8.77% of patients with MHE, 7.14% of patients with depressive episodes, and 4.27% of those with no mood disorders.

The researchers found that after adjusting for age, gender, education, hypertension, smoking, and use of psychotropic drugs, and depressive episodes, patients with MHE were 2.97 times more likely to develop CVD than patients with no mood disorders.

Patients with MHE were also 2.18 times more likely to develop CVD than patients with major depressive episodes only.

“This study supports previous reports of association between bipolar disorder and CVD and extends the potential relationship to focus on the longitudinal association between mania, hypomania, and incident CVD among community-dwelling persons,” Ramsey and team report in the Journal of Affective Disorders.

They say that the explanation for a greater risk for CVD in patients with MHE is likely to be multifactorial.

The team suggests biologic vulnerability as a potential explanation for their finding, noting that patients with MHE in their study were, on average, 5 years younger than those with depressive episodes and 9 years younger than those with no mood episodes.

“The physiological impact of labile mood and heightened affective states expedites the aging process, making manic, hypomanic, and bipolar individuals more prone to develop CVD and more vulnerable at a younger age,” they explain.

However, they say other possible reasons might include elevated levels of smoking and substance abuse or dependence in such patients, higher prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity, and the use of psychotropic medications.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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