Elevated Prevalence of Obesity, Metabolic Syndrome, and Cardiovascular Risk Factors in Bipolar Disorder

Department of Psychiatry, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.
Annals of Clinical Psychiatry (Impact Factor: 2.36). 07/2008; 20(3):131-7. DOI: 10.1080/10401230802177722
Source: PubMed


Bipolar disorder is associated with excess cardiovascular mortality. We hypothesized outpatients with bipolar disorder would exhibit excess cardiovascular risk factors, particularly among prevalent users of the second-generation antipsychotics associated with weight gain and valproic acid derivatives.
This chart review of 217 patients with bipolar disorder examined cardiovascular risk factors of the metabolic syndrome. We also evaluated if certain medications were cross-sectionally associated with metabolic syndrome.
Fifty-six patients were not weighed and many did not have available lipid profiles. Over three-quarters of those with available data (n = 161) were overweight or obese (body mass index >or= 25) and nearly half were obese (body mass index >or= 30). A prevalence exceeding general population estimates was also observed for hypertriglyceridemia, elevated blood pressure/hypertension, and elevated fasting glucose/diabetes. Among those with all requisite data (n = 60), over 50% met criteria for National Cholesterol Education Program-defined metabolic syndrome, nearly double the expected prevalence. A trend toward greater prevalence of metabolic syndrome among prevalent users of the second-generation antipsychotics associated with weight gain was observed.
Obesity and the metabolic syndrome were common in patients with bipolar disorder. These patients may be under-evaluated for cardiovascular risk and warrant screening and early intervention.

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    • "Furthermore, the loss of functional capacity cognitive impairment, and risk of developing rapid cycling bipolar disorder (RC-BD) appear to be enhanced by the presence of metabolic disturbances [1] [13]. Nevertheless, it is still unclear whether metabolic disturbances are the consequences or the leading factors of some of the health problems and maladaptive behaviors observed in BD [10] [11] [12]. "
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    ABSTRACT: Recent evidence shows an important relationship between metabolic disturbances and bipolar disorder (BD). However, it is still unclear whether such metabolic disturbances are only a consequence or to some extent the precipitating factors for health problems and maladaptive behaviors observed in BD. Because both metabolic disturbances and BD are medical conditions sharing common alterations in multiple biomarkers, it is plausible to hypothesize that metabolic disturbances may be considered to some extent as a major vulnerability factor in the latent phase of BD for some young adults. In line with this hypothesis , obesity may be regarded as a major driving force for prevalent cardio-metabolic disorders encountered within the early stages of BD. Likewise, premorbid metabolic disturbances as a whole may be considered as a potential source for vulnerability to develop BD. In addition, a synergistic relationship between obesity and metabolic disturbances associated with a premorbid disruption of biological rhythms may also lead to BD. Therefore, we postulate that metabolic disturbances may serve as a specific marker of premorbid illness activity in some people at risk for BD. Future prospective studies should focus on validating metabolic disturbances as vulnerability factors within the staging model of BD.
    Iranian Journal of Medical Hypotheses and Ideas 01/2015; 84(4). DOI:10.1016/j.mehy.2015.01.016
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    • "Comorbid medical conditions are frequent, long time hospitalization is common and suicide risk is high (20%) in bipolar disorder. Overall, the illness is an important socio-economic burden on the individual, family members and society (Fagiolini and Goracci, 2009; Fiedorowicz et al., 2008; Goldberg and Harrow, 2004; Kemp et al., 2014; McIntyre et al., 2008; Young and Grunze, 2013). BD is a highly heritable disease. "
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    ABSTRACT: Introduction: Glial Derived Neurotrophic Factor (GDNF) plays an important role in the survival and differentiation of neurons. We examined 5'upstream and 3' untranslated region of the GDNF gene by PCR amplification and direct sequencing to explore the effect of alteration in the potentially regulated part of GDNF in bipolar disorder. Materials and methods: Sixty-six patients with bipolar disorder, 27 first degree relatives of these patients and 56 healthy volunteers were screened for mutations and polymorphisms in GDNF gene. Results: Seven previously reported polymorphisms and additional three novel allele variants of GDNF were detected. Association test of rs2075680 C > A SNP showed significant difference between patients and healthy subjects with higher allele frequency in healthy subjects performing Chi-square test. However, there was no significant difference after multiple test corrections between groups. There were no significant differences in association test of rs2075680 C > A SNP between first degree relatives and healthy volunteers/patients. rs142426358 T > C SNP was seen only in one patient with an early age of illness onset. New T > A alterations were found in chromosome locations 5:37812784 and 5:37812782 in two male bipolar disorder patients with age of illness onset 12 and 24 years. Limitations: The sample size was relatively small. Discussion: Our study proposes the suggestive association between polymorphisms in the potential regulatory sites of GDNF and bipolar disorder.
    Journal of Affective Disorders 06/2014; 167C:244-250. DOI:10.1016/j.jad.2014.06.002 · 3.38 Impact Factor
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    • "Interestingly , in a community-based cohort of elderly men, higher (and high normal) plasma PTH levels were associated with a higher risk of cardiovascular mortality in the absence of hypercalcemia (Hagstrom et al. 2009). Missing these cases of isolated higher parathyroid levels is of particular concern as bipolar disorder per se is associated with an increased risk of cardiovascular mortality (Fiedorowicz et al. 2008). Furthermore, additional studies suggest an association between elevated parathyroid hormone levels and cognitive deficits in the absence of hypercalcemia (Jorde et al. 2006; Roman et al. 2005). "
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    ABSTRACT: Background Current screening recommendations for early detection of lithium-associated hyperparathyroidism propose an exclusive measurement of serum albumin-adjusted calcium (Aac) concentration as a single first step. However, longitudinal data in patients with recurrent affective disorders suggest that increases in serum intact parathyroid hormone (iPTH) levels in lithium-treated patients may not necessarily be accompanied by a parallel increase in the concentration of Aac. If true, patients with an isolated increase in iPTH concentration above the reference range might be missed following current screening recommendations. Therefore, this study set out to examine key parameters of calcium metabolism, including iPTH and 25-hydroxycholecalciferol concentrations in patients with bipolar disorder that was or was not managed with lithium. Methods Sixty patients with bipolar disorder according to DSM-IV were enrolled, 30 of whom had received long-term lithium treatment (lithium group), whereas the other 30 patients were on psychopharmacological treatment not including lithium (non-lithium group) at the time of the study. Owing to exclusion criteria (e.g., lithium < 6 months, laboratory results indicative of secondary hyperparathyroidism), 23 bipolar patients composed the final lithium group, whereas 28 patients remained in the non-lithium group for statistical analyses. Results Patients in the lithium group showed a significantly higher concentration of iPTH compared to the non-lithium group (p < 0.05). Similarly, Aac concentrations were significantly increased in the lithium group compared to the non-lithium group (p < 0.05). However, in a multivariate linear regression model, group affiliation only predicted iPTH concentration (p < 0.05). In line with this, none of the four patients in the lithium group with an iPTH concentration above the reference range had an Aac concentration above the reference range. Discussion This study suggests that the biochemical characteristics between primary hyperparathyroidism and lithium-induced hyperparathyroidism differ substantially with regard to regulation of calcium homeostasis. As such, current screening practice does not reliably detect iPTH concentrations above the reference range. Therefore, further research is needed to elucidate the consequences of an isolated iPTH concentration above the reference range in order to develop the most appropriate screening tools for hyperparathyroidism in lithium-treated patients with bipolar disorder.
    06/2013; 1(1). DOI:10.1186/2194-7511-1-7
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