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Cardiometabolic disease and features of depression and bipolar disorder: Population-based, cross-sectional study

  • Daniel J. Martin (a1), Zia Ul-Haq (a2), Barbara I. Nicholl (a3), Breda Cullen (a1), Jonathan Evans (a1), Jason M. R. Gill (a4), Beverly Roberts (a5), John Gallacher (a6), Daniel Mackay (a4), Andrew McIntosh (a7), Matthew Hotopf (a8), Nick Craddock (a6), Ian J. Deary (a5), Jill P. Pell (a4) and Daniel J. Smith (a1)...
Abstract
Background

The relative contribution of demographic, lifestyle and medication factors to the association between affective disorders and cardiometabolic diseases is poorly understood.

Aims

To assess the relationship between cardiometabolic disease and features of depresion and bipolar disorder within a large population sample.

Method

Cross-sectional study of 145 991 UK Biobank participants: multivariate analyses of associations between features of depression or bipolar disorder and five cardiometabolic outcomes, adjusting for confounding factors.

Results

There were significant associations between mood disorder features and ‘any cardiovascular disease’ (depression odds ratio (OR) = 1.15, 95% CI 1.12–1.19; bipolar OR = 1.28, 95% CI 1.14–1.43) and with hypertension (depression OR = 1.15, 95% CI 1.13–1.18; bipolar OR = 1.26, 95% CI 1.12–1.42). Individuals with features of mood disorder taking psychotropic medication were significantly more likely than controls not on psychotropics to report myocardial infarction (depression OR = 1.47, 95% CI 1.24–1.73; bipolar OR = 2.23, 95% CI 1.53–3.57) and stroke (depression OR = 2.46, 95% CI 2.10–2.80; bipolar OR = 2.31, 95% CI 1.39–3.85).

Conclusions

Associations between features of depression or bipolar disorder and cardiovascular disease outcomes were statistically independent of demographic, lifestyle and medication confounders. Psychotropic medication may also be a risk factor for cardiometabolic disease in individuals without a clear history of mood disorder.

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Copyright
Corresponding author
Daniel J. Smith, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH. UK. Email daniel.smith@glasgow.ac.uk
Footnotes
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This research has been conducted using the UK Biobank resource. UK Biobank was established by the Wellcome Trust medical charity, Medical Research Council, Department of Health, Scottish Government and the Northwest Regional Development Agency. It has also had funding from the Welsh Assembly Government and the British Heart Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Declaration of interest

None.

Footnotes
References
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1 Merikangas, KRI, Akiskal, HS, Angst, J, Greenberg, PE, Hirschfeld, RM, Petukhova, M, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication. Arch Gen Psychiatry 2007; 64: 543–52.
2 Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 617–27.
3 Martin, DJ, Smith, DJ. Is there a clinical prodrome of bipolar disorder? A review of the evidence. Expert Rev Neurother 2013; 13: 8998.
4 Ösby, U, Brandt, L, Correia, N, Ekbom, A, Sparén, P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry 2001; 58: 844–50.
5 Kemp, DE, Sylvia, LG, Calabrese, JR, Nierenberg, AA, Thase, ME, Reilly-Harrington, NA, et al. General medical burden in bipolar disorder: findings from the LiTMUS comparative effectiveness trial. Acta Psychiatr Scand 2014; 129: 2434.
6 McIntyre, R, Konarski, J, Soczynska, J, Wilkins, K, Panjwani, G, Bouffard, B, et al. Medical comorbidity in bipolar disorder: implications for functional outcomes and health service utilization. Psychiatr Serv 2006; 57: 1140–4.
7 Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851–8.
8 Stommel, M, Given, BA, Given, CW. Depression and functional status as predictors of death among cancer patients. Cancer 2002; 94: 2719–27.
9 Glassman, AH, Shapiro, PA. Depression and the course of coronary artery disease. Am J Psychiatry 1998; 155: 411.
10 Ormel, J, Von Korff, M, Burger, H, Scott, K, Demyttenaere, K, Huang, YQ, et al. Mental disorders among persons with heart disease - results from World Mental Health surveys. Gen Hosp Psychiatry 2007; 29: 325–34.
11 Fiedorowicz, JG, He, J, Merikangas, KR. The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample. J Psychosom Res 2011; 70: 145–54.
12 Herbst, S, Pietrzak, RH, Wagner, J, White, WB, Petry, NM. Lifetime major depression is associated with coronary heart disease in older adults: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med 2007; 69: 729–34.
13 Britvic, D, Maric, NP, Doknic, M, Pekic, S, Andric, S, Jasovic-Gasic, M, et al. Metabolic issues in psychotic disorders with the focus on first-episode patients: a review. Psychiatr Danub 2013; 25: 410–5.
14 Collins, R. What makes UK Biobank special? Lancet 2012; 379: 1173–4.
15 Smith, DJ, Nicholl, B, Cullen, B, Martin, D, Ul-Haq, Z, Evans, J, et al. Prevalence and characteristics of probable major depression and bipolar disorder within UK Biobank: cross-sectional study of 172,751 participants. PLoS One 2013; 8: e75362.
16 Langan, J, Mercer, SW, Smith, DJ. Multimorbidity and mental health: can psychiatry rise to the challenge? Br J Psychiatry 2013; 202: 391–3.
17 Ul-Haq, Z, Mackay, DF, Martin, D, Smith, DJ, Gill, JM, Nicholl, BI, et al. Heaviness, health and happiness: a cross-sectional study of 163 066 UK Biobank participants. J Epidemiol Community Health 2014; 68: 340–8.
18 Elderon, L, Whooley, MA. Depression and cardiovascular disease. Prog Cardiovasc Dis 2013; 55: 511–23.
19 Nordentoft, M, Wahlbeck, K, Hallgren, J, Westman, J, Osby, U, Alinaghizadeh, H, et al. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One 2013; 8: e55176.
20 Kessler, RC, McGonagle, KA, Swartz, M, Blazer, DG, Nelson, CB. Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. J Affect Disord 1993; 29: 8596.
21 Hwu, H-G, Joyce, PR, Karam, EG, Lee, C-K, Lellouch, J, Wickramaratne, PJ, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996; 276: 293–9.
22 De Hert, M, Correll, CU, Bobes, J, Cetkovich-Bakmas, M, Cohen, D, Asai, I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10: 5277.
23 Lahti, M, Tiihonen, J, Wildgust, H, Beary, M, Hodgson, R, Kajantie, E, et al. Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia. Psychol Med 2012; 42: 2275–85.
24 Trivedi, MH, Lin, EH, Katon, WJ. Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression. CNS Spectr 2007; 12 (suppl 13): 127.
25 Lacro, JP, Dunn, LB, Dolder, CR, Leckband, SG, Jeste, DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 2002; 63: 892909.
26 Gadkari, AS, McHorney, CA. Unintentional non-adherence to chronic prescription medications: how unintentional is it really? BMC Health Serv Res 2012; 12: 98.
27 Cramer, JA, Rosenheck, R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv 1998; 49: 196201.
28 Hare, DL, Toukhsati, SR, Johansson, P, Jaarsma, T. Depression and cardiovascular disease: a clinical review. Eur Heart J 2014; 35: 1365–72.
29 Ramsey, CM, Leoutsakos, JM, Mayer, LS, Eaton, WW, Lee, HB. History of manic and hypomanic episodes and risk of incident cardiovascular disease: 11.5 year follow-up from the Baltimore Epidemiologic Catchment Area Study. J Affect Disord 2010; 125: 3541.
30 Crump, C, Sundquist, K, Winkleby, MA, Sundquist, J. Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA Psychiatry 2013; 70: 931–9.
31 Weiner, M, Warren, L, Fiedorowicz, JG. Cardiovascular morbidity and mortality in bipolar disorder. Ann Clin Psychiatry 2011; 23: 40–7.
32 Shah, AS, Griffiths, M, Lee, KK, McAllister, DA, Hunter, AL, Ferry, AV, et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ 2015; 350: g7873.
33 Towfighi, A, Saver, JL, Engelhardt, R, Ovbiagele, B. A midlife stroke surge among women in the United States. Neurology 2007; 69: 1898–904.
34 Carney, RM, Freedland, KE. Depression in patients with coronary heart disease. Am J Med 2008; 121 (suppl 2): S207.
35 Freedland, KE, Carney, RM, Skala, JA. Depression and smoking in coronary heart disease. Psychosom Med 2005; 67 (suppl 1): S426.
36 Whooley, MA, de Jonge, P, Vittinghoff, E, Otte, C, Moos, R, Carney, RM, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300: 2379–88.
37 Heffner, JL, Strawn, JR, DelBello, MP, Strakowski, SM, Anthenelli, RM. The co-occurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations. Bipolar Disord 2011; 13: 439–53.
38 Ezzati, M, Henley, SJ, Thun, MJ, Lopez, AD. Role of smoking in global and regional cardiovascular mortality. Circulation 2005; 112: 489–97.
39 Rosmond, R, Björntorp, P. The hypothalamic–pituitary–adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 2000; 247: 188–97.
40 Watson, S, Gallagher, P, Ritchie, JC, Ferrier, IN, Young, AH. Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder. Br J Psychiatry 2004; 184: 496502.
41 Holsboer, F, Lauer, CJ, Schreiber, W, Krieg, JC. Altered hypothalamic-pituitary-adrenocortical regulation in healthy subjects at high familial risk for affective disorders. Neuroendocrinology 1995; 62: 340–7.
42 Watson, S, Gallagher, P, Del-Estal, D, Hearn, A, Ferrier, IN, Young, AH. Hypothalamic-pituitary-adrenal axis function in patients with chronic depression. Psychol Med 2002; 32: 1021–8.
43 Khanzode, SD, Dakhale, GN, Khanzode, SS, Saoji, A, Palasodkar, R. Oxidative damage and major depression: the potential antioxidant action of selective serotonin re-uptake inhibitors. Redox Rep 2003; 8: 365–70.
44 Kendler, KS, Gardner, CO, Fiske, A, Gatz, M. Major depression and coronary artery disease in the Swedish twin registry: phenotypic, genetic, and environmental sources of comorbidity. Arch Gen Psychiatry 2009; 66: 857–63.
45 Scherrer, JF, Xian, H, Bucholz, KK, Eisen, SA, Lyons, MJ, Goldberg, J, et al. A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosom Med 2003; 65: 548–57.
46 McCaffery, JM, Frasure-Smith, N, Dube, MP, Theroux, P, Rouleau, GA, Duan, Q, et al. Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med 2006; 68: 187200.
47 Torkamani, A, Topol, EJ, Schork, NJ. Pathway analysis of seven common diseases assessed by genome-wide association. Genomics 2008; 92: 265–72.
48 Hansson, GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352: 1685–95.
49 Joynt, KE, Whellan, DJ, O'Connor, CM. Depression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry 2003; 54: 248–61.
50 Rybakowski, JK, Wykretowicz, A, Heymann-Szlachcinska, A, Wysocki, H. Impairment of endothelial function in unipolar and bipolar depression. Biol Psychiatry 2006; 60: 889–91.
51 Steinberg, HO, Chaker, H, Leaming, R, Johnson, A, Brechtel, G, Baron, AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97: 2601–10.
52 Strike, PC, Steptoe, A. Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis 2004; 46: 337–47.
53 Allison, DB, Newcomer, JW, Dunn, AL, Blumenthal, JA, Fabricatore, AN, Daumit, GL, et al. Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med 2009; 36: 341–50.
54 Sernyak, MJ, Leslie, DL, Alarcon, RD, Losonczy, MF, Rosenheck, R. Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia. Am J Psychiatry 2002; 159: 561–6.
55 Baptista, T, Teneud, L, Contreras, Q, Alastre, T, Burguera, JL, de Burguera, M, et al. Lithium and body weight gain. Pharmacopsychiatry 1995; 28: 3544.
56 McIntyre, RS, Mancini, DA, McCann, S, Srinivasan, J, Kennedy, SH. Valproate, bipolar disorder and polycystic ovarian syndrome. Bipolar Disord 2003; 5: 2835.
57 Fava, M, Judge, R, Hoog, SL, Nilsson, ME, Koke, SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry 2000; 61: 863–7.
58 Faith, MS, Matz, PE, Jorge, MA. Obesity–depression associations in the population. J Psychosom Res 2002; 53: 935–42.
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Cardiometabolic disease and features of depression and bipolar disorder: Population-based, cross-sectional study

  • Daniel J. Martin (a1), Zia Ul-Haq (a2), Barbara I. Nicholl (a3), Breda Cullen (a1), Jonathan Evans (a1), Jason M. R. Gill (a4), Beverly Roberts (a5), John Gallacher (a6), Daniel Mackay (a4), Andrew McIntosh (a7), Matthew Hotopf (a8), Nick Craddock (a6), Ian J. Deary (a5), Jill P. Pell (a4) and Daniel J. Smith (a1)...
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