Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan, ROC; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
Biostatistics Center, Taipei Medical University, Taipei, Taiwan, ROC.
Kaohsiung J Med Sci. 2017 Dec;33(12):630-636. doi: 10.1016/j.kjms.2017.07.005. Epub 2017 Aug 10.
Aging patients with bipolar disorder (BD) are at a high risk of cardiovascular diseases (CVDs). However, few studies have directly examined the association between metabolic risks and CVDs in patients with BD across the lifespan. Therefore, the aim of this study was to determine lifetime metabolic risk factors for CVDs in patients with BD. We recruited BD-I patients who were more than 50 years old and had had at least one psychiatric hospitalization. Patients who had a cardiologist-confirmed CVD diagnosis (ICD-9 code 401-414) were assigned to the case group. Fifty-five cases were matched with 55 control patient without CVDs based on age and sex. Clinical data were obtained by retrospectively reviewing 30 years of hospital records. Compared to control subjects, a significantly higher proportion of cases had impaired fasting glucose between ages 31 and 40 (44.0% versus 17.4%, p = 0.046), diabetes mellitus between ages 41 and 50 (25.6% versus 8.6%, p = 0.054), and diabetes mellitus after age 51 (36.3% versus 12.7%, p = 0.005). No significant difference was found in overweight, obesity, or dyslipidemia. After adjusting for years of education, first episode as mania, and second generation antipsychotic use, lifetime diabetes mellitus remained a risk factor for CVDs (OR = 4.45, 95% CI = 1.89-10.66, p = 0.001). The findings suggest that glucose dysregulation across the adult age span is probably the major metabolic risk contributing to CVDs in patients with BD. Clinicians therefore have to notice the serum fasting glucose levels of BD patients since young adulthood.
患有双相情感障碍 (BD) 的老年患者患心血管疾病 (CVDs) 的风险很高。然而，很少有研究直接检查 BD 患者一生中代谢风险与 CVDs 之间的关系。因此，本研究旨在确定 BD 患者 CVDs 的终生代谢风险因素。我们招募了年龄在 50 岁以上且至少有一次精神科住院治疗的 BD-I 患者。有心脏病专家确诊的 CVD 诊断（ICD-9 代码 401-414）的患者被分配到病例组。根据年龄和性别，将 55 例病例与 55 例无 CVD 的对照患者匹配。通过回顾性审查 30 年的住院记录获得临床数据。与对照组相比，病例组在 31 至 40 岁之间有更多的空腹血糖受损（44.0%与 17.4%，p=0.046）、41 至 50 岁之间有更多的糖尿病（25.6%与 8.6%，p=0.054）、51 岁以后有更多的糖尿病（36.3%与 12.7%，p=0.005）。超重、肥胖或血脂异常在两组之间没有显著差异。在校正了受教育年限、首次发作躁狂和第二代抗精神病药物使用后，终生糖尿病仍然是 CVDs 的一个危险因素（OR=4.45，95%CI=1.89-10.66，p=0.001）。这些发现表明，成年期血糖失调可能是导致 BD 患者 CVDs 的主要代谢风险因素。因此，临床医生必须注意 BD 患者的血清空腹血糖水平，从成年早期开始。
