Minimizing Cardiovascular Risk in Bipolar Disorder
At the 2017 meeting of the American Association of Child and Adolescent Psychopharmacology, researcher Ben Goldstein gave an overview on cardiovascular risk and bipolar disorder. He noted a study by Nicole Kozloff and colleagues in the Journal of Affective Disorders in 2010 that indicated that onset of cardiovascular disorder occurred an average of 17 years earlier in those with BP I (at age 40-45 years) compared to controls (at age 55-60 years). Several risk factors made onset of cardiovascular disorder more likely, including diabetes, obesity, and the metabolic syndrome (which consists of any three of the five following symptoms: high cholesterol, triglycerides, blood sugar, blood pressure, and waist circumference).
Risk factors include pathophysiological and behavioral mechanisms and certain medications. Pathophysiological mechanisms include inflammation, oxidative stress, and autonomic and endothelial dysfunction.
Behavioral mechanisms include poor diet, exercise, sleep, and increases in tobacco and alcohol use.
Medications could also contribute, with the most to least problematic for weight gain including, among atypical antipsychotics: clozapine, olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, and lurasidone. Among mood stabilizers, worst to best for avoiding weight gain are: valproate, lithium, carbamazepine, oxcarbazepine, and lamotrigine.
Goldstein has data from retinal vascular photography (RVP), whereby blood vessels can be observed directly. As opposed to in adults, in youth large vessels are more problematic and arteriolar to venous ratio is abnormally higher in bipolar children compared to normal controls. This ratio is lower in bipolar adults, also reflecting increased cardiovascular risk.
Given the huge loss of life expectancy in bipolar disorder, primarily from cardiovascular disorders, Goldstein urges greater and earlier attention to reducing the pathophysiological, behavioral, and pharmacological mechanisms for poor health. These should be pursued in parallel with attempts at mood stabilization. Goldstein endorses the position of researcher James J. Hudziak that “all health begins with emotional health.”
Editor’s Note: One way to conceptualize good medical and emotional health is to consider the benefits of preserving telomere length. Telomeres are bits of genetic material that sit at the ends of DNA strands and protect the DNA during cell replication. Shorter telomeres are associated with aging and a host of medical and psychiatric illnesses.
Stress and numbers of depressive episodes shorten telomeres so that mitigating stressors and preventing depressions is a good place to start. A good diet, exercise, and practicing mindfulness or meditation are associated with longer telomeres, so adopting these lifestyle changes from an early age is ideal. It is noteworthy that lithium directly activates the enzyme telomerase that lengthens telomeres, and lithium normalizes their length in those with affective illness as a function of the duration of lithium treatment.
