APA 2009: Bipolar Disorder Linked to Higher Mortality Rates From Suicide and CVD

Barbara Boughton

May 20, 2009

May 20, 2009 (San Francisco, California) — Individuals with bipolar disorder suffer from higher rates of suicide as well as mortality from circulatory-system diseases and have increased risk for HIV infection, asthma, chronic obstructive pulmonary disease (COPD), and neurological conditions such as migraine, according to a series of studies presented here at the 162nd Annual American Psychiatric Association (APA) 2009 Annual Meeting.

The studies were part of an effort by the Spanish Society of Psychiatry to develop a consensus statement on the physical health of patients with bipolar disorder, according to Fernando Rico-Villademoros, MD, from the University of Alcalá, in Madrid, Spain.

"One of our most important findings was that, as well as suicide, patients with bipolar disorder have higher rates of mortality due to cardiovascular disease. However, there are no strong data that they suffer from cancer at higher rates than the general population," Dr. Rico-Villademoros told Medscape Psychiatry.

"The reasons for the higher rates of death from cardiovascular disease are multifactorial — and are probably due to the medications patients take as well as lifestyle," he added.

Higher Rates of Cardiovascular and Cerebrovascular Disease

Dr. Fernando Rico-Villademoros

In the studies, researchers surveyed the published literature from 1966 to January 2008 but limited their search to studies published in English and Spanish.

The mortality study surveyed research that reported all-cause mortality and cause-specific mortality. Three other studies on cancer and HIV infection, neurological comorbidities, and cardiovascular and respiratory comorbidities included papers with a sample size of 30 or more patients but excluded those that evaluated the effect of comorbidities associated with a specific treatment for bipolar disorder, such as lithium or antipsychotics. The studies did not include a meta-analysis and only provided descriptive results of the primary studies found in the literature search.

In the mortality study, the researchers found that the standardized mortality ratio for suicide in patients with bipolar disorder ranged from just above 8 to 20. A standardized mortality ratio of 1 is a mortality rate considered no different from the reference population. Patients with bipolar disorder also died from circulatory-system diseases — including cardiovascular and cerebrovascular disease — at rates higher than the general population, and 2 studies also showed a higher mortality rate due to infection.

In a study that evaluated cardiovascular and respiratory comorbidities, the researchers showed that bipolar disorder was associated with higher rates of asthma and COPD and less consistently with an increased rate of hypertension. There was no association between bipolar disorder and stroke.

Migraine Finding Difficult to Explain

Another study on neurological comorbidities found patients with bipolar disorder seemed to suffer from an increased incidence of migraine compared with the general population — a finding that is difficult to explain, Dr. Rico-Villademoros said.

There was also an association between bipolar disorder and dementia; a finding that the researchers said should be investigated further. However, because of the limited number of studies evaluating these neurological comorbidities — 21 in all — they also noted that their findings on these risks should be interpreted with caution.

The investigators also looked at the risk of cancer and HIV infection and found a limited number of studies on these subjects — 5 on cancer morbidity and 8 on HIV infection. Although their data are not conclusive, they did find that bipolar disorder may be associated with an increased rate of HIV, but not cancer.

Taken together, the research points to the importance of evaluating risk factors for comorbidities in patients with bipolar disorder, including cardiovascular-disease risk factors and those for infection, including drug use, Dr. Rico-Villademoros said.

"Although we always focus on suicide, it's important to take into account other factors as well."

Data Support Clinical Experience

"These studies are completely consistent with the viewpoint of most clinicians — and it's nice to have data to support our knowledge about the risks of suicide as well as cardiovascular disease in patients with bipolar disorder," commented David Baron, MD, from Temple University School of Medicine, in Philadelphia, Pennsylvania, and a member of the APA scientific program committee.

"The mortality study underscores the truth that psychiatric disease is a life-threatening disorder. Many people think those with bipolar disorder are just sad or manic, but it's truly a biopsychosocial disease," Dr. Baron added.

The studies were funded by Bristol-Myers Squibb and Otsuka Pharmaceuticals. Dr. Rico-Villademoros and Dr. Baron disclosed no relevant financial relationships.

American Psychiatric Association 2009 Annual Meeting: Abstracts NR1-008, NR1-067, NR1-084, NR1-094. Presented May 18, 2009.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: