title: Association between history of psychosis and cardiovascular disease in bipolar disorder.
abstract: OBJECTIVE
  To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder.
  
  
  METHODS
  This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature.
  
  
  RESULTS
  In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08).
  
  
  CONCLUSIONS
  The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.|Departamento de Psiquiatría, Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: Miguel L
authors.identifier: http://orcid.org/0000-0001-5578-4605
authors.initials: ML
authors.lastname: Prieto
authors.affiliation: Lindner Center of HOPE, Mason, OH, USA.|Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Sharonne N
authors.initials: SN
authors.lastname: Hayes
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Sutor
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Kung
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Bobo
authors.affiliation: Department of Psychiatry, Facultad de Medicina Clínica Alemana/Universidad del Desarrollo, Santiago, Chile.
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Fuentes
authors.affiliation: Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México.
authors.forename: Alfredo B
authors.initials: AB
authors.lastname: Cuellar-Barboza
authors.affiliation: Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Crow
authors.affiliation: Department of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Ösby
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Chauhan
authors.affiliation: Department of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Westman
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Geske
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Colin L
authors.initials: CL
authors.lastname: Colby
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Euijung
authors.initials: E
authors.lastname: Ryu
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.|Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Biernacka
authors.affiliation: Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Rochester, MN, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000145:classification / Q000453:epidemiology* / Q000523:psychology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology; D012720:Severity of Illness Index
keywords: bipolar disorder; cardiovascular diseases; hypertension; phenotype; risk