Most people think of bipolar disorder as a purely psychological disorder, an illness of the mind, not the body. This is a flawed concept. Firstly, bipolar disorder is a physical disorder in and of itself as seen in changes in brain structure and function, meaning it does not just entail shifts in mood. More than that, though, bipolar disorder is linked to a number of other physical illnesses. People with bipolar disorder tend to have shorter lifespans than the general population. Part of that is the high risk of suicide, but other factors involve diseases associated with bipolar disorder. One such disease is cardiovascular disease, which is the number one cause of death among those with bipolar disorder.
Cardiovascular disease is a broad term that covers several heart conditions. One of the biggest factors in heart disease is plaque buildup in the walls of the arteries (atherosclerosis). This buildup restricts blood flow, which can cause clots to form. There are several types of cardiovascular disease including:
- Blood clots that can lead to both heart attacks and strokes.
- A heart attack that occurs when a clot cuts off blood supply to the heart. When this happens, the heart muscle begins to die.
- Strokes occur when blood vessels to the brain are blocked. When blood supply to the brain is cut off, brain cells begin to die.
- Congestive heart failure in which the heart does not pump as well as it should, limiting the supply of blood and oxygen to the body.
- Arrhythmia in which the heart beats irregularly. It can pump either too slowly or too quickly, each can cause problems with blood flow and oxygen levels.
- Heart valve problems that occur when heart valves don’t open or close properly or prolapse, causing problems with blood flow and possibly regurgitation.
Just as there are several types of heart disease, there are also several reasons why it might be more common in people with bipolar disorder than the general population.
- Obesity is incredibly common in people with bipolar disorder with more than half of people with the disorder being overweight. Obesity greatly increases the chances for cardiovascular disease.
- Hypertension may also be more common in people with bipolar disorder. Patients with higher blood pressure tend to have more manic episodes than those without high blood pressure.
- Type 2 diabetes is also three times more common in people with bipolar disorder. Having type 2 diabetes is often tied to being overweight or obese.
- Hyperlipidemia (high concentration of fat in the blood) and specifically hypertriglyceridemia is 20% more common in people with bipolar disorder.
- Metabolic syndrome has a prevalence of up to 50% in people with bipolar disorder compared to 27% in the general population. Metabolic syndrome increases chances for cardiovascular disease as well as diabetes.
- Substance use and cigarette smoking are more common in people with bipolar disorder, both of which can lead to heart disease.
Many of the factors that contribute to the increased risk of cardiovascular disease in bipolar disorder have to do with a person’s weight. There are several reasons that people with bipolar disorder tend to be overweight.
- Eating disorders, especially binge eating disorder, are more common in people with bipolar disorder than the general population.
- In atypical depression, patients can gain a significant amount of weight, at least 10%.
- Most medications used to treat bipolar disorder cause weight gain that is incredibly difficult to fight against.
Considering all of these factors, it is important that patients all of their doctors monitor risks for cardiovascular disease. It is treatable with lifestyle changes such as diet, exercise and quitting smoking and substance use. Heart disease can also be managed with medication. One major factor is to manage stress and depression, which leads us full circle back to the psychological treatment of bipolar disorder.
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