A recent Johns Hopkins University study suggests that people with a history of manic or hypomanic episodes have an increased risk for cardiovascular disease (CVD).[1]

“Recognition of manic symptoms and addressing related CVD risk factors could have long-term preventative implications in the development of CVD in the community,” according to Christine Ramsey and colleagues at the University.

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

To investigate, the researchers examined the history of mania 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 mania, 71 with major depressive episodes only, and 1,339 with no mood episodes were psychiatrically assessed in 1981 and 1982.

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

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

Patients with mania 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 an increased risk for CVD in patients with bipolar mania is most likely to be multi-factorial.

The research team suggests that a potential explanation for their finding could be biologic vulnerability, noting that patients with mania in their study were, on average, five years younger than those with depressive episodes and nine 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 that other possible explanations might be elevated levels of smoking and substance abuse or dependence in such patients, hypertension, higher prevalence of cardiovascular risk factors such as diabetes, obesity, and the use of psychotropic medications.


[1] http://psychcentral.com/news/2010/06/11/mania-increases-risk-for-cardiovascular-illness/14493.html