Risk factors for early cardiovascular mortality in patients with bipolar disorder

Aim: We attempted to determine risk factors, particularly pathophysiological changes, for early cardiovascular mortality in bipolar disorder (BD). Methods: A total of 5416 inpatients with bipolar I disorder were retrospectively followed through record linkage for cause of death. A total of 35 patients dying from cardiovascular disease (CVD; ICD 9: 401-443) before the age of 65years were identified. Two living BD patients and two mentally healthy adults were matched with each deceased patient as control subjects according to age (±2years), sex, and date (±3years) of the final/index admission or the date of general health screening. Data were obtained through medical record reviews. Results: Eighty percent of CVD deaths occurred within 10years following the index admission. Conditional logistic regression revealed that the variables most strongly associated with CVD mortality were the leukocyte count and heart rate on the first day of the index hospitalization, as the deceased BD patients were compared with the living BD controls. Systolic pressure on the first day of the index hospitalization can be substituted for heart rate as another risk factor for CVD mortality. Conclusion: It is suggested that systemic inflammation and sympathetic overactivity during the acute phase of BD may be risk factors for early CVD mortality.