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Time effect on cardiometabolic risk indicators in patients with bipolar disorder: a longitudinal case-control study.

ABSTRACT: Individuals with bipolar disorder are at increased risk for cardiovascular diseases. Most studies have described increases in cardiometabolic risk indicators (CMRIs) using clinical cut-off values. Further, there are no longitudinal studies on CMRIs. We aimed to investigate continuous measures of CMRIs in individuals with bipolar disorder and controls using both cross-sectional and longitudinal data. We used data from the Swedish St. Göran Bipolar project. Study individuals were examined at baseline and after a median of 6 and 7 years for the control and patient group, respectively. Data were collected December 2005-December 2020. The cohort included 281 individuals with bipolar disorder (mean age 39 years, 59% women) and 114 controls (mean age 38 years, 55% women). Of those, 155 patients and 74 controls also provided follow-up data. At baseline, individuals with bipolar disorder had significantly higher mean values of waist-to-hip ratio (WHR) (β = 0.142, p = 0.001), body mass index (β = 0.150, p = 0.006), plasma triacylglycerol (TAG) (β = 0.218, p < 0.001), total/plasma high-density lipoprotein-cholesterol (TChol/HDL-C) ratio (β = 0.103, p = 0.03), TAG/HDL-C ratio (β = 0.151, p = 0.006), and non-HDL-C (β = 0.168, p = 0.001) than controls. Most CMRIs remained higher in the patient group at follow-up. The difference between patients and controls increased over time for WHR (0.005 unit/year, p < 0.001), and systolic (1.1 mm Hg/year, p = 0.002) and diastolic (0.8 mm Hg/year, p < 0.001) blood pressure. Individuals with bipolar disorder displayed persistently higher levels of nearly all included CMRIs. Over time, a subset of CMRIs worsened in patients relative to controls. This suggests that active measures to counter cardiovascular risk in persons with bipolar disorder should be considered.

SUBMITTER: Najar H

PROVIDER: S-EPMC10359211 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Time effect on cardiometabolic risk indicators in patients with bipolar disorder: a longitudinal case-control study.

Najar Hemen H Joas Erik E Pålsson Erik E Landén Mikael M

European archives of psychiatry and clinical neuroscience 20221123 5

Individuals with bipolar disorder are at increased risk for cardiovascular diseases. Most studies have described increases in cardiometabolic risk indicators (CMRIs) using clinical cut-off values. Further, there are no longitudinal studies on CMRIs. We aimed to investigate continuous measures of CMRIs in individuals with bipolar disorder and controls using both cross-sectional and longitudinal data. We used data from the Swedish St. Göran Bipolar project. Study individuals were examined at basel ...[more]

PMID: 36422678

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Project description:BackgroundOffspring of parents with bipolar disorder (BD-I/II) are at increased risk to develop the disorder. Previous work indicates that bipolar spectrum disorder (BPSD) is often preceded by mood/anxiety symptoms. In school-age offspring of parents with BD, we previously built a risk calculator to predict BPSD onset, which generates person-level risk scores. Here, we test whether preschool symptoms predict school-age BPSD risk.MethodsWe assessed 113 offspring of parents with BD 1-3 times during preschool years (2-5 years old) and then approximately every 2 years for a mean of 10.6 years. We used penalized (lasso) regression with linear mixed models to assess relationships between preschool mood, anxiety, and behavioral symptoms (parent-reported) and school-age predictors of BPSD onset (i.e., risk score, subthreshold manic symptoms, and mood lability), adjusting for demographics and parental symptomatology. Finally, we conducted survival analyses to assess associations between preschool symptoms and school-age onset of BPSD and mood disorder.ResultsOf 113 preschool offspring, 33 developed new-onset mood disorder, including 19 with new-onset BPSD. Preschool irritability, sleep problems, and parental factors were lasso-selected predictors of school-age risk scores. After accounting for demographic and parental factors, preschool symptoms were no longer significant. Lasso regressions to predict mood lability and subthreshold manic symptoms yielded similar predictors (irritability, sleep problems, and parental affective lability), but preschool symptoms remained predictive even after adjusting for parental factors (ps < .005). Exploratory analyses indicated that preschool irritability univariately predicted new-onset BPSD (p = .02) and mood disorder (p = .02).ConclusionsThese results provide initial prospective evidence that, as early as preschool, youth who will develop elevated risk scores, mood lability, and subthreshold manic symptoms are already showing symptomatology; these preschool symptoms also predict new-onset BPSD. While replication of findings in larger samples is warranted, results point to the need for earlier assessment of risk and development of early interventions.

Project description:BackgroundAbnormalities in cerebrospinal fluid (CSF)-amyloid-beta (Aβ)42, CSF-Aβ40, CSF-Aβ38, CSF-soluble amyloid precursor proteins α and β, CSF-total-tau, CSF-phosphorylated-tau, CSF-neurofilament light protein (NF-L), CSF-neurogranin, plasma-Aβ42, plasma-Aβ40, plasma-total-tau, plasma-NF-L and, serum-S100B during affective episodes may reflect brain changes that could impact cognitive function in patients with bipolar disorder (BD). The study aimed to investigate the association between these biomarkers indicative of Alzheimer's disease and those reflecting neurodegeneration alongside their impact on cognitive function in patients with BD and healthy control individuals (HC). The primary hypothesis was that GL and VL would increase with increasing levels of CSF-Aβ42 based on data from T0 and T3 in BD and HC jointly.MethodsIn a prospective, longitudinal case-control study euthymic patients with BD (N = 85) and HC (N = 44) were evaluated with clinical assessment and neuropsychological testing at baseline (T0) and during euthymia after a year (T3). Patients' affective states were recorded weekly as euthymic, subthreshold level, major depression, or (hypo)mania. If an episode occurred during follow-up, the patient was also assessed in post-episode euthymia. Cognitive performance was measured as a global cognitive score (GL) for four cognitive domains including verbal learning and memory (VL).ResultsEstimated in a linear mixed model GL increased with 0.001 for each increase of 1 pg/ml of CSF-Aβ42 (97.5%, CI 0.00043-0.0018, adjusted-p = 0.0005) while VL increased by 0.00089 (97.5%, CI 0.00015-0.0018, adjusted-p = 0.045) in BD and HC jointly. The association was weak, however stronger in patients with BD compared to HC. Associations between other biomarkers including CSF-neurogranin, and cognitive domains were overall weak, and none remained significant after adjustment for multiple testing.LimitationsModest sample size. A complete data set regarding both CSF-AB-42 and cognitive test scores was obtained from merely 61 patients with BD and 38 HC individuals.ConclusionCSF-Aβ42 may be associated with cognitive dysfunction in patients with BD and HC individuals. The association appeared to be stronger in BD but with overlapping confidence intervals. Hence it remains uncertain whether the association is a general phenomenon or driven by BD.

Project description:BackgroundToxoplasma gondii (T. gondii) is the most successful obligate protozoan that can infect warm-blooded vertebrate hosts. Some researchers suggest that the presence of Toxoplasma cysts in the brain can lead to mental disorders. Bipolar disorder (BD) is one of the serious neuropsychiatric disorders. Several studies have shown a high seroprevalence of T. gondii in bipolar patients. Therefore, this study aims to determine the prevalence of this infection in patients with BD.MethodsIn this case-control study, anti-Toxoplasma immunoglobulin (Ig) G and IgM antibodies were measured in serum samples from 115 patients with BD and 115 subjects without this disorder from the general population using commercially available enzyme-linked immunosorbent assay. Demographic characteristics of the patient and control groups, information about T. gondii infection and BD, and their potential risk factors were analyzed. We utilized the Mann-Whitney U test for continuous variables, the chi-square test for categorical data, and multivariate logistic regression to assess T. gondii infection and BD, with significance set at P < 0.05.ResultsTwenty-eight (24.34%) of 115 patients with BD and 10 (8.7%) of 115 controls had anti-T. gondii IgG antibodies. IgM antibodies against T. gondii were not reported to be positive in any participants. Furthermore, there was a statistically significant difference in the results [odds ratio (OR) = 2.89: 95% confidence interval (CI) = 1.08-7.73. P = 0.03]. Within the study population, various factors were identified as significant risk factors for BD: sex (OR 8.10, 95% CI 3.16-20.75), age 20-50 (OR 5.11, 95% CI 1.81-14.45), age over 50 (OR 19.54, 95% CI 4.02-94.89), education level (OR 0.24, 95% CI 0.09-0.60), working status (non-employment, OR 4.12, 95% CI 1.65-10.30), and income (middle, OR 0.29, 95% CI 0.10-0.89; high, OR 0.12, 95% CI 0.01-0.77), all with P-values less than 0.05. In addition, in the group of patients, there was no statistically significant relationship between T. gondii infection with the type of bipolar disease (P = 0.93), the severity of the disease (P = 0.61), and the history of suicide attempts (P = 0.63).ConclusionThis study showed that toxoplasmosis is a risk factor for BD and increases the chance of developing BD. However, more studies with a larger sample size are recommended to clarify the development pathways of this disorder and provide new strategies for the prevention and treatment of this disease.Clinical trialNot applicable.

Dataset Information

Time effect on cardiometabolic risk indicators in patients with bipolar disorder: a longitudinal case-control study.

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Time effect on cardiometabolic risk indicators in patients with bipolar disorder: a longitudinal case-control study.

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