Sex-specific associations between lifetime diagnosis of bipolar disorder and cardiovascular disease: A cross-sectional analysis of 257,673 participants from the UK Biobank

• Published in: Journal of affective disorders 2022-12, Vol.319, p.663-669
• Main Authors: Ortiz, Abigail, Sanches, Marcos, Abdelhack, Mohamed, Schwaiger, Tyler R., Wainberg, Michael, Tripathy, Shreejoy J., Felsky, Daniel, Mulsant, Benoit H., Fiedorowicz, Jess G.
• Format: Article
• Language: English
• Subjects: Biological Specimen Banks; Biomarkers; Bipolar disorder; Bipolar Disorder - complications; Bipolar Disorder - diagnosis; Bipolar Disorder - epidemiology; Cardiovascular; Cardiovascular Diseases - complications; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Coronary artery disease; Coronary Artery Disease - complications; Cross-Sectional Studies; Essential Hypertension; Female; Heart Failure; Humans; Male; Mood disorders; Morbidity; Risk Factors; Sex; United Kingdom - epidemiology
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.09.048

Sex is seldom considered as a potential moderator of the impact of bipolar disorder (BD) on cardiovascular disease (CVD) risk. We aimed to characterize the sex-specific association of CVD and BD using data from the UK Biobank. In a cross-sectional analysis, we compared the odds ratio between women and men with BD for seven CVD diagnoses (coronary artery disease, myocardial infarction, angina, atrial fibrillation, heart failure, stroke, and essential hypertension) and four cardiovascular biomarkers (arterial stiffness index, low-density lipoprotein, C-reactive protein, and HbA1c) in 293 participants with BD and 257,380 psychiatrically healthy controls in the UK Biobank. After adjusting for age, we found a two- to three-fold stronger association among women than among men between BD and rates of coronary artery disease, heart failure, and essential hypertension, with a significant sex-by-diagnosis interactions. The association remained significant after controlling for self-reported race, education, income, and smoking status. After controlling for potential confounders, there was no significant association between sex and any cardiovascular biomarkers. These analyses could not disentangle effects of BD from its treatment. Our results underscore the importance of incorporating sex and mental illness in risk estimation tools for CVD, and improving screening for, and timely treatment of, CVD in those with BD. Future research is needed to better understand the contributors and mechanisms of sex differences related to CVD risk in BD. •Sex is seldom considered a moderator of the impact of bipolar on cardiovascular risk.•We characterized this sex-specific association using data from the UK Biobank.•Two- to three-fold stronger association among women with bipolar.•Moderation by sex in the association between bipolar and cardiovascular disease.•Critical to incorporate sex and mental illness in risk estimation tools.