Comparison of Cardiovascular Disease Risk Indicators in Bipolar Disorder Patients with Healthy Controls
Abstract
Aim: It is important to assess the likelihood of cardiovascular disease in patients with bipolar disorder (BD). In this study, indicators of increased cardiovascular disease risk on electrocardiogram (ECG) and laboratory were evaluated.
Material and Methods: In the present investigation, we studied the demographic details, ECG variables, and blood test results of 90 healthy controls (HC) and 97 patients we followed for BD diagnosis.
Results: Age and gender trends were similar between the BD and HC groups (p=0.844 and p=0.664). BD had a higher mean number of fragmented QRS (fQRS) than the HC group, and fQRS was more frequent (p=0.002 and p=0.007). The frontal QRS-T angle was wider in the BD group than it was in the HC group (p=0.038). Monocyte-to-lymphocyte ratio (MLR), monocytes to high-density lipoprotein cholesterol (HDL-C) ratio (MHR), and atherogenic index of plasma (AIP) were statistically greater in BD patients (p=0.021, p<0.001, and p<0.001).
Conclusion: In brief, the report indicates that impaired ventricular repolarization is related to an elevation in the frontal QRS-T angle in BD. As a result, BD patients have a greater risk of cardiovascular mortality and ventricular arrhythmias. As a result, clinicians ought to have a greater understanding of the frontal QRS-T angle and conduct an ECG examination on regular controls.
References
- Skjelstad DV, Malt UF, Holte A. Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. J Affect Disord. 2010;126:1-13.
- Bauer M, Pfennig A. Epidemiology of bipolar disorders. Epilepsia. 2005;46:8-13.
- Osby U, Brandt L, Correia N, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58:844–50.
- Kilbourne AM, Cornelius JR, Han X, et al. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord. 2004;6:368-73.
- Fenn HH, Bauer MS, Altshuler L, et al. Medical comorbidity and health-related quality of life in bipolar disorder across the adult age span. J Affect Disord. 2005;86:47-60.
- Goldberg JF. Treatment guidelines: current and future management of bipolar disorder. J Clin Psychiatry. 2000;61:12-8.
- Abuş S, Kapıcı Y, Ayhan S, et al. Comparative study of frontal QRS-T angle and inflammatory parameters in obsessive compulsive disorder patients and healthy control group. Medicine Science. 2022;11:1473-7.
- Abuş S, Afşin A. Fragmented QRS in the relatives of patients with coronary artery disease. Ann Noninvasive Electrocardiol. 2022;27:e12970.
- Kalelioğlu T, Ünalan P, Kök B, et al. Atherogenic index of plasma as a cardiovascular risk marker in manic, depressive, and euthymic stages of bipolar disorder. Turk Kardiyol Dern Ars. 2018;46:32-8.
- Nunes SOV, Piccoli de Melo LG, Pizzo de Castro MR, et al. Atherogenic index of plasma and atherogenic coefficient are increased in major depression and bipolar disorder, especially when comorbid with tobacco use disorder. J Affect Disord. 2015;172:55–62.
- American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington: American Psychiatric Publishing.
- Bazett HC. An Analysis of the time-relations of electrocardiograms. Heart. 1920;7:353.
- Scott JL, Walls RM. QT interval prolongation. J Emerg Med. 1985;3:221–5.
- Newcomer JW. Medical risk in patients with bipolar disorder and schizophrenia. J Clin Psychiatry. 2006;67:e16
- Mainar A, Blanca-Tamayo M, Rejas-Gutiérrez J, Navarro- Artieda R. Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a crosssectional assessment of a primary health care database. Eur Psychiatry. 2008;23:100–8.
- Goldstein BI. Bipolar disorder and the vascular system: mechanisms and new prevention opportunities. Can J Cardiol. 2017;33:1565–76.
- Tuomisto K, Jousilahti P, Sundvall J, et al. C-reactive protein, interleukin-6 and tumor necrosis factor alpha as predictors of incident coronary and cardiovascular events and total mortality. A population-based, prospective study. Thromb Haemost. 2006;95:511-8.
- Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.
- Bortolasci CC, Vargas HO, Vargas Nunes SO, et al. Factors influencing insulin resistance in relation to atherogenicity in mood disorders, the metabolic syndrome and tobacco use disorder. J Affect Disord. 2015;179:148–55.
- Adibfar A, Saleem M, Lanctot KL1, Herrmann N. Potential biomarkers for depression associated with coronary artery disease: a critical review. Curr Mol Med. 2016;16:137–64.
- Eisen A, Arnson Y, Dovrish Z, et al. Arrhythmias and conduction defects in rheumatological diseases: a comprehensive review. Semin Arthritis Rheum. 2009;39:145-56.
- Kadi H, Inanir A, Habiboglu A, et al. Frequency of fragmented QRS on ECG is increased in patients with rheumatoid arthritis without cardiovascular disease: a pilot study. Mod Rheumatol. 2012;22:238-42.
- Çetin M, Kocaman SA, Erdoğan T, et al. The independent relationship of systemic inflammation with fragmented QRS complexes in patients with acute coronary syndromes. Korean Circ J. 2012;42:449-57.
- Tekin A, Tanrıverdi Z, Kapıcı Y, et al. Comparison of frontal QRS-T angle in patients with schizophrenia and healthy volunteers. J Psychiatr Res. 2022;149:76-82.
- Harringan EP, Miceli JJ, Anziano R, et al. A randomized evaluation of the effects of six antipsychotic agent on the QTc, in the absence and presence of metabolic inhibition. J Clin Psychopharmacol. 2004;24:62–9.
Abstract
Amaç: Bipolar bozukluğu (BB) olan hastalarda kardiyovasküler hastalık olasılığını değerlendirmek önemlidir. Literatüre göre frontal QRS-T kardiyovasküler hastalık göstergesi olabilir.
Materyal ve Metot: Bu araştırmada, 90 sağlıklı kontrol (SK) ve BB tanısı ile takip ettiğimiz 97 hastanın demografik bilgilerini, elektrokardiyogram (EKG) değişkenlerini ve kan testi sonuçlarını inceledik.
Bulgular: Yaş ve cinsiyet dağılımı BB ve SK grupları arasında benzerlik göstermekteydi (p=0,844 ve p=0,664). BB'de SK grubuna göre daha yüksek ortalama fragmente QRS (fQRS) sayısı vardı ve fQRS daha sıktı (p=0,002 ve p=0,007). Frontal QRS-T açısı BB grubunda SK grubuna göre daha genişti (p=0,038). Monosit-lenfosit oranı (MLO), monosit/yüksek yoğunluklu lipoprotein kolesterol (HDL-C) oranı (MHO) ve plazma aterojenik indeksi (PAI) BB hastalarında istatistiksel olarak daha yüksekti (p=0.021, p<0.001 ve p<0.001).
Sonuç: Özetle, bu rapor bozulmuş ventriküler repolarizasyonun, BB'de frontal QRS-T açısındaki bir yükselme ile ilişkili olduğunu göstermektedir. Sonuç olarak, BB hastalarında kardiyovasküler mortalite ve ventriküler aritmi riski daha yüksektir. Sonuç olarak klinisyenler frontal QRS-T açısını daha iyi anlamalı ve rutin kontrollerde EKG incelemesi yapmalıdır.
References
- Skjelstad DV, Malt UF, Holte A. Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. J Affect Disord. 2010;126:1-13.
- Bauer M, Pfennig A. Epidemiology of bipolar disorders. Epilepsia. 2005;46:8-13.
- Osby U, Brandt L, Correia N, et al. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58:844–50.
- Kilbourne AM, Cornelius JR, Han X, et al. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord. 2004;6:368-73.
- Fenn HH, Bauer MS, Altshuler L, et al. Medical comorbidity and health-related quality of life in bipolar disorder across the adult age span. J Affect Disord. 2005;86:47-60.
- Goldberg JF. Treatment guidelines: current and future management of bipolar disorder. J Clin Psychiatry. 2000;61:12-8.
- Abuş S, Kapıcı Y, Ayhan S, et al. Comparative study of frontal QRS-T angle and inflammatory parameters in obsessive compulsive disorder patients and healthy control group. Medicine Science. 2022;11:1473-7.
- Abuş S, Afşin A. Fragmented QRS in the relatives of patients with coronary artery disease. Ann Noninvasive Electrocardiol. 2022;27:e12970.
- Kalelioğlu T, Ünalan P, Kök B, et al. Atherogenic index of plasma as a cardiovascular risk marker in manic, depressive, and euthymic stages of bipolar disorder. Turk Kardiyol Dern Ars. 2018;46:32-8.
- Nunes SOV, Piccoli de Melo LG, Pizzo de Castro MR, et al. Atherogenic index of plasma and atherogenic coefficient are increased in major depression and bipolar disorder, especially when comorbid with tobacco use disorder. J Affect Disord. 2015;172:55–62.
- American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington: American Psychiatric Publishing.
- Bazett HC. An Analysis of the time-relations of electrocardiograms. Heart. 1920;7:353.
- Scott JL, Walls RM. QT interval prolongation. J Emerg Med. 1985;3:221–5.
- Newcomer JW. Medical risk in patients with bipolar disorder and schizophrenia. J Clin Psychiatry. 2006;67:e16
- Mainar A, Blanca-Tamayo M, Rejas-Gutiérrez J, Navarro- Artieda R. Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a crosssectional assessment of a primary health care database. Eur Psychiatry. 2008;23:100–8.
- Goldstein BI. Bipolar disorder and the vascular system: mechanisms and new prevention opportunities. Can J Cardiol. 2017;33:1565–76.
- Tuomisto K, Jousilahti P, Sundvall J, et al. C-reactive protein, interleukin-6 and tumor necrosis factor alpha as predictors of incident coronary and cardiovascular events and total mortality. A population-based, prospective study. Thromb Haemost. 2006;95:511-8.
- Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.
- Bortolasci CC, Vargas HO, Vargas Nunes SO, et al. Factors influencing insulin resistance in relation to atherogenicity in mood disorders, the metabolic syndrome and tobacco use disorder. J Affect Disord. 2015;179:148–55.
- Adibfar A, Saleem M, Lanctot KL1, Herrmann N. Potential biomarkers for depression associated with coronary artery disease: a critical review. Curr Mol Med. 2016;16:137–64.
- Eisen A, Arnson Y, Dovrish Z, et al. Arrhythmias and conduction defects in rheumatological diseases: a comprehensive review. Semin Arthritis Rheum. 2009;39:145-56.
- Kadi H, Inanir A, Habiboglu A, et al. Frequency of fragmented QRS on ECG is increased in patients with rheumatoid arthritis without cardiovascular disease: a pilot study. Mod Rheumatol. 2012;22:238-42.
- Çetin M, Kocaman SA, Erdoğan T, et al. The independent relationship of systemic inflammation with fragmented QRS complexes in patients with acute coronary syndromes. Korean Circ J. 2012;42:449-57.
- Tekin A, Tanrıverdi Z, Kapıcı Y, et al. Comparison of frontal QRS-T angle in patients with schizophrenia and healthy volunteers. J Psychiatr Res. 2022;149:76-82.
- Harringan EP, Miceli JJ, Anziano R, et al. A randomized evaluation of the effects of six antipsychotic agent on the QTc, in the absence and presence of metabolic inhibition. J Clin Psychopharmacol. 2004;24:62–9.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences, Internal Diseases |
| Journal Section | Original Articles |
| Authors | |
| Early Pub Date | May 15, 2023 |
| Publication Date | May 15, 2023 |
| Acceptance Date | February 17, 2023 |
| Published in Issue | Year 2023 Volume: 5 Issue: 2 |
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Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
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