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AHA: Teens with major depression, bipolar disorder at risk for early CVD
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Major depressive disorder and bipolar disorder in adolescents are moderate-risk conditions associated with accelerated atherosclerosis and early CVD, according to a scientific statement from the American Heart Association.
Benjamin I. Goldstein, MD, PhD, chair of the writing group, and colleagues summarized existing research showing major depressive disorder and bipolar disorder during the teenage years are associated with accelerated atherosclerosis and early CVD, and offered suggestions for risk stratification and management strategies.
Awareness low
“Youth with mood disorders are not yet widely recognized as a group at increased risk for excessive and early heart disease,” Goldstein, a child-adolescent psychiatrist at Sunnybrook Health Sciences Centre, Toronto, and the University of Toronto, said in a press release. “We hope these guidelines will spur action from patients, families and health care providers to reduce the risk of [CVD] among these youth.”
Goldstein and colleagues acknowledged evidence in the literature showing that teens with major depressive disorder or bipolar disorder are more likely to have high BP, elevated cholesterol, obesity, type 2 diabetes and atherosclerosis compared with teens without either disorder.
“Although limited in scope, available findings from youth with [major depressive disorder] and [bipolar disorder] are largely convergent with adult findings,” the authors wrote. “Future studies based on representative population samples of youth with [bipolar disorder] are needed. Prospective studies incorporating repeated measures of mood and traditional CVD risk factors are needed to better understand the bidirectional relationships between these variables among youth with [major depressive disorder] and [bipolar disorder].”
Pathophysiological processes that connect mood disorders and CVD include inflammation, oxidative stress and autonomic dysfunction, according to the statement.
Contributors to CVD risk among youth and adults with major depressive disorder or bipolar disorder also include behavioral and environmental factors such as early maltreatment, sleep disturbance, sedentary lifestyle, poor nutrition and tobacco use, the authors wrote. They noted that there is little research on how alcohol and substance abuse might contribute to CVD risk in this population, and that these factors do not fully explain the connection.
Medication connection
Some psychotropic medications administered to youth with major depressive disorder or bipolar disorder can contribute to CVD risk, according to the statement. The authors noted that some antidepressant medications and mood-stabilizing medications can cause weight gain and have adverse consequences on other metabolic parameters, though there is no evidence that they cause increases on CVD incidence or mortality, possibly because of their anti-inflammatory effects.
The statement recommends that CVD risk in this population be managed in accordance with the strategies for moderate-risk conditions as outlined in the 2006 report from the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents.
For teens with two or more risk factors according to those guidelines, management according to strategies for high-risk conditions should apply, according to the statement.
“To meaningfully change the [CV] risk associated with [major depressive disorder] and [bipolar disorder] among youth, a concerted effort across stakeholder groups will be required, including pediatricians and other primary care providers, psychiatrists, patients and their families, research funding agencies and policy makers,” Goldstein and colleagues wrote. – by Erik Swain
Disclosure: Goldstein reports no relevant financial disclosures. See the full statement for a full list of author and reviewer disclosures.
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