Comorbidities of Bipolar Disorder & Heart Disease

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Patients with bipolar disorder experience cardiovascular mortality at elevated rates in comparison to the general population. The mortality ratio for cardiovascular diseases in patients with bipolar disorder versus the general population ranges from 1.5 to 4, depending on the studies.

There are several mechanisms that explain the increased risk of cardiovascular diseases in patients with bipolar disorder.

First of all, bipolar patients often have risk factors associated with heart disease. For instance, bipolar patients tend to be obese. Kilbourne (2004) reported that about one-third of bipolar patients have high blood pressure and high cholesterol levels, and about one-fifth are diagnosed with diabetes. Beyer (2005) reported that 11% of a sample of mixed age outpatient population with bipolar disorder had cardiovascular diseases and hypertension.

Garcia-Portilla and colleagues studied 194 patients with bipolar disorder, with an average age of 47 years, from 13 centres in Spain. They found that about two-third of patients are either overweight or obese. About one-half of the patients smoked and about one-third of the patients had high blood pressure and cholesterol. They also showed that the 10-year risk of dying of cardiovascular disease is highest for men with bipolar disorder (10.2%). For women in the study, the average 10-year risk is 4.7%.

Second, treatment of bipolar disorder may have adverse effects on cardiovascular systems. A recent study conducted by Nemeroff and colleagues suggested that antipsychotics, antidepressants and mood stabilizers used to treat bipolar disorder may be associated with an increased risk of cardiovascular disease (Nemeroff et al., 2002).

In summary, psychiatrists should be aware that bipolar disorder increases risk for heart disease. Psychiatrists should work with primary care doctors to monitor cardiovascular risk factors in bipolar patients, including smoking, blood pressures, cholesterol levels to prevent cardiovascular events in bipolar patients.


Kilbourne, et al. 2004. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disorders Volume 6 Issue 5, Pages 368 – 373

[My paper] Maria P Garcia-Portilla, Pilar A Saiz, Maria T Bascaran, Sara Martínez A, Antonio Benabarre, Pilar Sierra, Pedro Torres, Jose Manuel Montes, Manuel Bousoño, Julio Bobes. Cardiovascular risk in patients with bipolar disorder. J Affect Disord 2008 Oct 25: 18954911 (P,S,G,E,B,D)

Nemeroff CB. 2003. Safety of available agents used to treat bipolar disorder: focus on weight gain. J Clin Psychiatry 64: 532–539.