AHA, CVD mood disorder and bipolar artwork

Young people with mood disorders have an increased risk of developing early cardiovascular disease, according to a scientific statement from the American Heart Association released Monday.

Published in the journal Circulation, the paper said more doctors should begin actively monitoring and intervening on that risk. While the links between depression and adult cardiovascular disease are well known, the statement called on more awareness and action in catching the risks among youth with mood disorders.

The paper looked at several studies that evaluated the presence of major depressive mood disorders and bipolar disorders and links to early onset of cardiovascular disease and related deaths.

“This is really something people should be looking at. We think of mood disorders as mental illnesses, but they also have physical manifestations,” said Dr. Benjamin Goldstein, the statement’s chief author. “It is well known if you look at adults with mood disorders, they don’t get the same standard of care for heart disease or stroke. We want to make sure that doesn’t happen to teenagers.”

In 2011, an expert panel identified four conditions – chronic inflammatory disease, human immunodeficiency virus, Kawasaki disease, and nephrotic syndrome – that predispose young people to a moderate risk of developing atherosclerosis before 30 years old. Atherosclerosis is a buildup of plaque in the arteries that can lead to heart attack and stroke.

Monday’s statement said major depressive mood disorder and bipolar disorder meet all the same criterion for risk as these conditions – but that they are even more widespread in adolescents than all four of the conditions combined. The prevalence of these mood disorders in the United States among adolescents is about 10 percent.

Depressive mood disorder and bipolar disorder are the first- and fourth-most disabling conditions, among adolescents worldwide, according to the scientific statement. Bipolar disorder involves repeated episodes of mania or hypomania, which is elated or irritable moods together with other symptoms. They generally, but not always, alternate with episodes of depression, a sadness or lack of interest or pleasure. Depressive mood disorder typically involves episodes of depression without the mania or hypomania.

Goldstein said most cardiologists know that depression can adversely affect heart and stroke patients, but the fact that it can bring on heart risk is something that is still “off the radar.”

And even farther off the scope is the concept that risk markers for atherosclerosis have been observed among people with mood disorders before the age of 30.

“My hope is that the routine treatment of bipolar disorder or major depressive disorder for youth includes an assessment for cardiovascular risk,” said Goldstein, a psychiatrist and director of the Centre for Youth Bipolar Disorder at Sunnybrook Health Sciences Centre in Toronto.

In general, mood disorders are commonly linked with cardiovascular disease risk factors such as smoking, weight gain, high levels of stress and sleep disruption. But the AHA’s statement said there also are links between heart disease and mood disorders that point to a shared biology – “pathophysiological mechanisms such as inflammation, oxidative stress, autonomic dysfunction, and endothelial dysfunction.”

One study discussed in the statement, The National Health and Nutritional Examination Survey from 2011, concluded that diagnoses of clinical depression were associated with increased deaths from ischemic heart disease. The risk of death attributed to depressive mood disorder was 13 percent among males (the fourth-strongest risk factor after obesity, smoking and hypertension) and 65 percent among females (the strongest risk factor). The study included 7,641 participants, 17 to 39 years of age from 1988 to 1994, and followed this group until 2006.

Goldstein said a “transformational change” is needed – more awareness and regular screening and intervention – to change the future for so many children and youth with mood disorders.

“Because mood disorders are highly prevalent among adolescents, and are generally amenable to treatment, there could be substantial cardiovascular benefits associated with improved identification, monitoring, and treatment of these conditions, with potential public health implications,” the statement said. “Importantly, mood disorders that begin in childhood or adolescence are known to persist into adulthood and are known to be especially pernicious variants of these disorders, with far greater burden of psychiatric symptoms as compared to adult-onset mood disorders.”