Shot Through the Heart, And Bipolar Disorder’s To Blame: You Have a Higher Risk of Cardiovascular Disease If You’re Bipolar

A blue heart made of neon-colored light. Credit to flickr.com user Sarah C. Used with permission under a creative commons license.

As if suffering from bipolar disorder wasn’t bad enough, research has shown that people with the psychiatric condition have a much greater risk of cardiovascular disease. People with bipolar disorder tend to have shorter lifespans as well, 25 years shorter on average. Some might assume that’s because of the increased propensity of suicide, but the number one killer of people with bipolar disorder is cardiovascular disease. If you’re bipolar, you have a 5 times greater risk of death during a heart attack. Even the late Carrie Fisher, long-time advocate for mental health and bipolar icon, died of one.

Cardiovascular disease is an umbrella term covering many different forms of heart issues. Among them are blood clots, heart attacks, strokes, congestive heart failure, heart valve problems, and arrhythmia, where the heart beats too slowly or too quickly.

But why do cardiovascular diseases strike people with bipolar disorder so much more than the rest of the population?

Let’s dig in.

Risk Factors

There are several risk factors for cardiovascular disease, many of which relate to being overweight and weight gain. The most common risks tied to bipolar disorder and cardiovascular disease are:

• Obesity: More than half of the people who suffer from bipolar disorder are overweight. Obesity is defined by a body mass index of greater than 30. Being that overweight puts you at risk of premature atherosclerosis (the hardening of the arteries), as well as increased risk of heart attacks and heart failure.
• Hypertriglyceridemia: Hypertriglyceridemia, a high concentration of fatty acids in the blood, is 20% more common in people with bipolar disorder compared to the general population. Elevated levels of triglycerides are associated with atherosclerosis, and predispose people to cardiovascular disease. People who are obese will convert more calories to triglycerides, which can lead to hypertriglyceridemia.
• Type 2 Diabetes: Type 2 diabetes is 3 times more common in bipolar patients, and is often associated with being overweight. People with type 2 diabetes tend to develop cardiovascular disease at a younger age, have more severe cardiovascular disease and more complications from it, and are more likely to have asymptomatic, or “silent,” cardiovascular disease.
• Hypertension (High Blood Pressure): A 2004 study showed that about 30% of bipolar patients have high blood pressure and high cholesterol levels. Bipolar patients with hypertension tend to have more manic episodes than those without high blood pressure. Researchers from a 2010 study discovered that nearly 50% of patients hospitalized with bipolar disorder suffer from high blood pressure, and the younger a person develops the psychiatric condition, the more likely he or she is likely to develop hypertension.
• Smoking: Studies have shown that the rate of smoking among people with bipolar disorder is 50-70%, compared with 20% of the general population. Self-medicating with cigarettes and other substances can also contribute to cardiovascular disease.
• Metabolic Syndrome: According to Wikipedia, metabolic syndrome is “a clustering of at least three of the five following medical conditions: central obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein.” The condition affects up to 50% of people suffering from bipolar disorder, compared to 27% of the general population, and increases the risk of cardiovascular disease and diabetes.
• Psych Meds: Also of note is the use of psychiatric medications–a class of drugs including mood stabilizers, antidepressants, and antipsychotics–and how they affect the ability to survive a heart attack. A study published in The European Heart Journal showed that if you combine an old-school antipsychotic and any antidepressant, you have an 18-fold increase in death during a cardiac arrest. Combining antidepressants with any antipsychotic causes an over 5-fold increase in risk of death during a heart attack. (A tip of the hat to: Mad In America.) But antidepressants alone are a risk factor for heart attacks. A 2015 study showed that tricyclic antidepressant users had a 36 percent increased risk of heart attack regardless of other factors.

Many of the risk factors for cardiovascular disease in bipolar disorder have to do with weight. And many people with bipolar disorder struggle with weight gain. But why? There are several reasons. For one, if you’re depressed, you may eat more and move less, which contributes to weight gain. Most medications that are used to treat bipolar disorder pack on the pounds, and then contribute to the inability to shed that weight. And more than 14% of bipolar patients suffer from eating disorders, including binge eating. (Incidentally, see another article on The Bipolar Parent to understand how bipolar disorder manifests differently in people who binge eat.)

Solutions

With all this dire news, you might be feeling scared. But fear not! There are ways to lower your risk of cardiovascular disease, most of which involve lifestyle changes.

Weight-Related Solutions: If you are 80 pounds overweight and drop just 10 pounds, you can cut your risk of heart disease in half. Maintaining a healthy diet and exercise program can help you lose weight. Another thing that can cut your risk in half is performing 10 minutes per day of moderate exercise. If you struggle with your weight, changing your medications to those that cause less weight gain might be an option for you, depending on what your psychiatrist says.

Non-Weight-Related Solutions: Quitting smoking has a dramatic effect on the heart: one year after stopping cigarette use, the risk of heart disease drops to half that of current smokers. After 15 years, the risk is nearly that of a non-smoker. If possible, try to change your psychiatric medications to those that don’t have the deadly combination of an old-school antipsychotic and an antidepressant. Sleep is crucial for managing both your bipolar disorder and the health of your heart.

Of course, trying to avoid a heart attack in the first place is your best bet. But if you find yourself suffering from cardiovascular disease, there are ways to manage your condition. Diet, exercise, sleep, and stress reductions can all help.

I wish you luck in your journey.

• Why Medicinal Weight Gain is Devastating to the Mentally Ill
• How Sugar May Harm Your Mental Health
• Good, Good, Good Nutrition, Part II: Foods to Avoid When Managing Bipolar Disorder

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