Cardiometabolic risk indicators in bipolar disorders

Abstract: In addition to disabling mood episodes, bipolar disorders (BDs) predispose individuals to high cardiovascular disease (CVD) risk. This thesis explores the association between BDs and the metabolic risk indicators body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, and lipid profile. Study I showed no differences in weight gain or increase in BMI between individuals with BDs on mood stabilizer monotherapy compared with age- and sex-matched individuals with BDs who received treatment with a second-generation antipsychotic in addition to a mood stabilizer. Study II showed that individuals with BDs had higher mean levels of WHR, BMI, and atherogenic lipid profile compared with a control group. A sub-group of individuals with BDs and controls were followed-up after a period of 6–7 years. We found an increase in WHR and blood pressure in the patient group relative to the controls after the follow-up period. Study III partly replicated the findings of Study II using an independent cohort with a nearly identical study protocol and a follow-up of 7–8 years. Study IV compared the secular trends and the distribution of BMI between individuals with BDs and the general population in Sweden. The mean levels of BMI were higher in the patient group and increased more over time compared with the general population. Women with BDs and individuals with high BMI had the largest annual increase in BMI. In conclusion, individuals with BDs have a higher CVD risk-profile as measured by cardiometabolic risk indicators. It is important that clinicians adopt a proactive strategy, look at the overall picture, and observe minor changes in cardiometabolic status to prevent cardiometabolic disease generally and in individuals with BDs specifically.