title: Long-term risk of myocardial infarction and stroke in bipolar I disorder: A population-based Cohort Study.
abstract: OBJECTIVE
  To estimate the risk of fatal and non-fatal myocardial infarction (MI) and stroke in patients with bipolar I disorder compared to people without bipolar I disorder.
  
  
  METHODS
  Utilizing a records-linkage system spanning 30 years (1966-1996), a population-based cohort of 334 subjects with bipolar I disorder and 334 age and sex-matched referents from Olmsted County, Minnesota, U.S. was identified. Longitudinal follow-up continued until incident MI or stroke (confirmed by board-certified cardiologist/neurologist), death, or study end date (December 31, 2013). Cox proportional hazards models assessed the hazard ratio (HR) for MI or stroke, adjusting for potential confounders.
  
  
  RESULTS
  There was an increased risk of fatal or non-fatal MI or stroke (as a composite outcome) in patients with bipolar I disorder [HR 1.54, 95% confidence interval (CI) 1.02, 2.33; p=0.04]. However, after adjusting for baseline cardiovascular risk factors (alcoholism, hypertension, diabetes, and smoking), the risk was no longer significantly increased (HR 1.19, 95% CI 0.76, 1.86; p=0.46).
  
  
  CONCLUSIONS
  Small sample size for the study design. Findings were not retained after adjustment for cardiovascular disease risk factors. Psychotropic medication use during the follow-up was not ascertained and was not included in the analyses.
  
  
  CONCLUSIONS
  This study in a geographically defined region in the U.S. demonstrated a significant increased risk of MI or stroke in bipolar I disorder, which was no longer significant after adjustment for cardiovascular risk factors.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile.
authors.forename: Miguel L
authors.initials: ML
authors.lastname: Prieto
authors.affiliation: Division of Biomedical Statistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Schenck
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kruse
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Klaas
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Bobo
authors.affiliation: AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.affiliation: Fondation FondaMental, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; INSERM, U955, Psychiatrie Génétique, Créteil, France; Hôpital H. Mondor-A. Chenevier, Département de Psychiatrie, Créteil, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Rocca
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: mfrye@mayo.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: Bipolar disorder; Cardiovascular diseases; Cohort studies; Risk
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