Search

Much of the excess mortality in bipolar disorder can be attributed to medical comorbidities, particularly cardiometabolic disorders. This observation has been noted for more than a century. The proportion of excess mortality attributable to cardiovascular disease has increased in recent years. In addition to mortality, there are increased cardiovascular risk factors in bipolar disorder across the life span. The prevalence of these comorbidities is thought to be elevated by aberrations in particular biological pathways, including inflammation, oxidative stress, and neurotrophic factors. Medical comorbidities significantly affect the lives of patients with bipolar disorder in the form of decreased treatment response, increased symptom severity, and increased mortality risk. To successfully ameliorate the negative impacts of medical comorbidities on patients with bipolar disorder, an integrated emphasis on cardiometabolic health alongside mental health is warranted, including behavioral, pharmacological, and systems-related approaches.

The authors identified individual randomized controlled trials from previous meta-analyses and additional searches, and then performed meta-analyses on cardiovascular disease outcomes and all-cause mortality. The authors assessed publications from 2012, both before and including the U.S. Preventive Service Task Force review. Their systematic reviews and meta-analyses showed generally moderate- or low-quality evidence for preventive benefits (folic acid for total cardiovascular disease, folic acid and B-vitamins for stroke), no effect (multivitamins, vitamins C, D, β-carotene, calcium, and selenium), or increased risk (antioxidant mixtures and niacin [with a statin] for all-cause mortality). Conclusive evidence for the benefit of any supplement across all dietary backgrounds (including deficiency and sufficiency) was not demonstrated; therefore, any benefits seen must be balanced against possible risks.