Prieto M L, Cuéllar-Barboza A B, Bobo W V, Roger V L, Bellivier F, Leboyer M, West C P, Frye M A
Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA; Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile.
Acta Psychiatr Scand. 2014 Nov;130(5):342-53. doi: 10.1111/acps.12293. Epub 2014 May 22.
To review the evidence on and estimate the risk of myocardial infarction and stroke in bipolar disorder.
A systematic search using MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and bibliographies (1946 - May, 2013) was conducted. Case-control and cohort studies of bipolar disorder patients age 15 or older with myocardial infarction or stroke as outcomes were included. Two independent reviewers extracted data and assessed quality. Estimates of effect were summarized using random-effects meta-analysis.
Five cohort studies including 13 115 911 participants (27 092 bipolar) were included. Due to the use of registers, different statistical methods, and inconsistent adjustment for confounders, there was significant methodological heterogeneity among studies. The exploratory meta-analysis yielded no evidence for a significant increase in the risk of myocardial infarction: [relative risk (RR): 1.09, 95% CI 0.96-1.24, P = 0.20; I(2) = 6%]. While there was evidence of significant study heterogeneity, the risk of stroke in bipolar disorder was significantly increased (RR 1.74, 95% CI 1.29-2.35; P = 0.0003; I(2) = 83%).
There may be a differential risk of myocardial infarction and stroke in patients with bipolar disorder. Confidence in these pooled estimates was limited by the small number of studies, significant heterogeneity and dissimilar methodological features.
回顾双相情感障碍患者心肌梗死和中风风险的相关证据并进行评估。
利用MEDLINE、EMBASE、PsycINFO、Web of Science、Scopus、Cochrane系统评价数据库进行系统检索，并查阅文献目录（1946年至2013年5月）。纳入以15岁及以上双相情感障碍患者发生心肌梗死或中风为结局的病例对照研究和队列研究。两名独立评审员提取数据并评估质量。采用随机效应荟萃分析总结效应估计值。
纳入五项队列研究，共13115911名参与者（其中双相情感障碍患者27092名）。由于使用了不同的登记系统、统计方法以及对混杂因素的调整不一致，各研究之间存在显著的方法学异质性。探索性荟萃分析未发现心肌梗死风险显著增加的证据：[相对风险（RR）：1.09，95%置信区间0.96 - 1.24，P = 0.20；I² = 6%]。虽然有证据表明研究存在显著异质性，但双相情感障碍患者中风风险显著增加（RR 1.74，95%置信区间1.29 - 2.35；P = 0.0003；I² = 83%）。
双相情感障碍患者心肌梗死和中风风险可能存在差异。这些汇总估计的可信度因研究数量少、显著异质性和不同的方法学特征而受到限制。
