title: High serum sodium level in affective episode associated with coronary heart disease in old adults with bipolar disorder.
abstract: OBJECTIVE
  Coronary heart disease (CHD) remains the principal cause of excessive natural deaths in bipolar patients; however, electrocardiogram analyses and clinical features predicting CHDs in elderly bipolar patients remain limited. We sought to examine the relationship between CHDs, as determined by electrocardiogram, and clinical characteristics.
  
  
  METHODS
  We recruited bipolar I outpatients Diagnostic Statistical Manual of Mental Health (DSM-IV) who were more than 60 years old and had at least one psychiatric admission. Subjects were divided into two groups based on the presence or absence of CHD diagnosed by electrocardiogram analysis at entry of study. Clinical data were obtained by a combination of interviewing patients and family members and retrospectively reviewing medical records of the most recent acute psychiatric hospitalization.
  
  
  RESULTS
  Eighty patients with bipolar disorder were enrolled. A total of 20 (25%) in the study had CHDs. The mean age at the time of entry into study was 67.6 ± 5.5 years old in group with CHD and 66.8 ± 6.8 years old in that without CHD. Among the clinical characteristics examined, higher mean levels of serum sodium and thyroxine during the acute affective phase as well as more first-degree family history with bipolar disorder were related to having CHD, particularly the serum sodium level.
  
  
  CONCLUSIONS
  About one fourth of old bipolar patients have CHDs in both Asian and Western populations. Aging patients with bipolar disorder may have unique clinical factors (e.g., hypernatremia or elevated thyroxine) related CHDs that could warrant special attention in their psychiatric and medical care to minimize cardiovascular disease and mortality.
authors.affiliation: Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Pao-Huan
authors.initials: PH
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ariel G
authors.initials: AG
authors.lastname: Gildengers
authors.affiliation: Department of Health Business Administration, Meiho University, Pingtung, Taiwan.
authors.forename: Chao-Hsien
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Meng-Ling
authors.initials: ML
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Chian-Jue
authors.initials: CJ
authors.lastname: Kuo
authors.affiliation: Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan tmcpsyts@tmu.edu.tw.
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Tsai
mesh_terms: D000339:Affect / Q000502:physiology*; D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012964:Sodium / Q000097:blood*; D013223:Statistics as Topic; D013624:Taiwan; D013974:Thyroxine / Q000097:blood
chemical_list: D012964:Sodium; D013974:Thyroxine
keywords: Bipolar disorder; cardiovascular disease; coronary heart disease; elderly; serum sodium; thyroid