Cardiovascular conditions may be overlooked in bipolar disorder

Cardiovascular comorbidities may be going under-recognized and undertreated in patients with bipolar disorder, say UK researchers.

This is despite the UK having a healthcare system that is free at the point of access, they note.

“This systematic under-recognition and undertreatment of cardiovascular disease may contribute to substantial premature mortality for individuals with a bipolar diagnosis in the UK,” write lead researcher Daniel Smith (University of Glasgow, UK) and co-workers in BMC Medicine.

The team studied the medical records of 2582 patients with bipolar disorder, who comprised 0.2% of a larger sample of primary practice patients representing about a third of the population of Scotland.

Two major cardiovascular comorbidities – coronary heart disease (CHD) and hypertension – were no more commonly recorded in bipolar patients than other patients after accounting for age and gender. In fact, hypertension was significantly less common.

The researchers say this is, on the face of it, unexpected, given the known increased rates of cardiovascular disease mortality in bipolar disorder. However, they note that rates of vascular risk factors were markedly elevated in patients with bipolar disorder; for example, diabetes was 31% more common than in non-bipolar patients.

In line with previous studies, “[o]ur findings suggest a strong likelihood of under-recording of cardiovascular disease in bipolar disorder,” they surmise. Under-recording could be partly due to patient factors, says the team, with bipolar patients inhibited from visiting their doctor during mood episodes and by factors such as social isolation.

However, the under-recording of cardiovascular comorbidities in bipolar patients was accompanied by undertreatment. Patients with bipolar disorder who also had CHD were 55% more likely to smoke than controls with CHD, were twice as likely to not be receiving antihypertension medication, and half as likely to be taking multiple antihypertensives.

Smith et al note that they cannot definitively ascribe lack of antihypertension treatment to undertreatment without knowing patients’ blood pressure. Yet bipolar patients with CHD were also 31% less likely to be taking a statin and “it is important to note that for people with CHD statins are recommended for all patients irrespective of pretreatment cholesterol level, so lack of prescription is indicative of a missed opportunity to deliver an evidence-based intervention.”

The researchers say: “Our results in relation to prescribing are potentially of concern because the adherence to cardiovascular medication in individuals with major mental illness may be even lower than the prescribing data suggests.”

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