The relationship and predictors of electrocardiography, inflammatory markers, clinical features in older bipolar and schizophrenia patients concurrent with coronary heart and cerebro-vascular diseases

Cardiovascular disease (CVD) is a major source of medical comorbidity for patients with bipolar disorder and schizophrenic disorders, and it remains the leading public health burden for the general population in industrialized nations. Cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, an unhealthy diet and harmful use of alcohol. Indirect neurobiological evidence suggests that preclinical risk for atherosclerosis, the main contributor to CVD, may be conferred by interindividual variation in the functionality of the amygdala, a brain system jointly involved in processing behaviorally salient stimuli and regulating the cardiovascular system. Several inflammatory markers are known, such as P-selectin, interleukin (IL)-6, IL-1, tumor necrosis factor (TNF), soluble intercellular adhesion molecule-1, and fibrinogen, but hs-CRP has emerged as the most powerful inflammatory predictor of future cardiovascular risk. There are increasing evidence that patients with bipolar disorder and schizophrenia are accompanied by activated inflammatory response systems and autonomic dysfunction. These facts may explain the excessive mortaility and morbility of cardiovascular disorders. It remains unclear how is the the effect of pathophysiology of psychotic disorders and on the circulatory system. The aims of this study are (1) to explore the relationship between circulatory systems and pathophysiology of psychotic disorder regarding inflammatory response system and electrocardiography (2) bioplogical risk factor or predictors of cardiovascular disease of bipolar disorder and schizophrenia (3) the comorbidity of coronary heart disease and cerebrovascular disease. The patients diagnosed as bipolar I disorder or schizophrenia and aged over 45 years, without actively abusing alcohol or substance will be recruited. They will receive physical examination, psychiatric and cognitive assessment, electrocardiography, and venous blood sampling. The cardiovascular diseasea related inflammatory markerw will be checked, sucha as (soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin-1 receptor antagonist (IL-1Ra), soluble interleukin-6 receptor (sIL-6R),soluble interleukin-2 receptor (sIL-2R), high-sensitivity CRP (hs-CRP). Patients living in the community while entering the study will be yearly followed up. Patients hospitalized at acute ward while entering the study will be followed up before discharge, 6 months later, and 18 months later. It is estimated a total of 210 schizophrenic patients and 135 bipolar patients and 345 age-and sex-matched normal controls recruited in the study. Hopefully, the biological predictor of cardiovascular disease will be found to prevent the mortality of cardiovascular diseases.