Department of Neurosciences, University of Turin, Via Cherasco 15, 10126 Turin, Italy.
Int J Mol Sci. 2024 Nov 15;25(22):12286. doi: 10.3390/ijms252212286.
Borderline personality disorder (BPD) is a complex psychiatric disorder characterized by an unstable sense of self and identity, emotional dysregulation, impulsivity, and disturbed interpersonal relationships. This narrative review examines the interplay between dysregulation of the autonomic nervous system, metabolic changes, and cardiovascular risk in BPD. Altered heart rate variability (HRV), reflecting the dysregulation of the autonomic nervous system, is associated with some BPD core symptoms, such as emotional instability and impulsivity. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, often stemming from early trauma, contributes to chronic inflammation and elevated allostatic load, which further increases cardiovascular risk. Metabolic dysfunctions in BPD, such as elevated body mass index (BMI), high blood pressure, and inflammatory markers like C-reactive protein (CRP), exacerbate these risks. Speckle-tracking echocardiography, particularly global longitudinal strain (GLS) and biomarkers such as homocysteine and epicardial fat, could be considered early predictors of cardiovascular events in individuals with BPD. Chronic stress, inflammation, and maladaptive stress responses further heighten cardiovascular vulnerability, potentially accelerating biological aging and cognitive decline. A literature search covering the period from 2014 to 2024 on PubMed identified 189 studies on this topic, of which 37 articles were deemed eligible for this review. These included cross-sectional, longitudinal, case-control, randomised controlled trials (RCTs), reviews, and meta-analysis designs, with sample sizes ranging from 14 to 5969 participants. The main limitations were that only one database was searched, the time of publications was limited, non-English manuscripts were excluded, and the quality of each paper was not commented on. This narrative review aims to provide an overview of recent evidence obtained on this topic, pointing out a direction for future research.
边缘型人格障碍（BPD）是一种复杂的精神疾病，其特征是自我和身份不稳定、情绪调节障碍、冲动和人际关系紊乱。这篇叙述性综述探讨了自主神经系统失调、代谢变化和心血管风险之间的相互作用在 BPD 中的作用。心率变异性（HRV）的改变，反映了自主神经系统的失调，与 BPD 的一些核心症状有关，如情绪不稳定和冲动。下丘脑-垂体-肾上腺（HPA）轴的失调，通常源于早期创伤，导致慢性炎症和适应负荷增加，进一步增加心血管风险。BPD 中的代谢功能障碍，如体重指数（BMI）升高、高血压和炎症标志物如 C 反应蛋白（CRP）升高，加剧了这些风险。斑点追踪超声心动图，特别是整体纵向应变（GLS）和生物标志物，如同型半胱氨酸和心外膜脂肪，可以被认为是 BPD 患者心血管事件的早期预测指标。慢性应激、炎症和适应不良的应激反应进一步增加了心血管的脆弱性，可能加速生物衰老和认知衰退。对 2014 年至 2024 年期间 PubMed 上的文献进行搜索，共确定了 189 项关于该主题的研究，其中 37 篇文章被认为符合本综述的标准。这些研究包括横断面、纵向、病例对照、随机对照试验（RCT）、综述和荟萃分析设计，样本量从 14 到 5969 名参与者不等。主要的局限性在于只搜索了一个数据库，出版物的时间有限，排除了非英语文献，并且没有对每篇论文的质量进行评论。本综述旨在提供关于该主题的最新证据概述，指出未来研究的方向。
