A new study has revealed that young adults with bipolar disorder may already experience subtle heart dysfunction long before the onset of heart failure.
Published in Biological Psychiatry by Elsevier, the research highlights early changes in heart muscle performance that could put this population at higher risk for cardiovascular disease—the leading cause of premature death among patients with bipolar disorder worldwide.
The study, which examined participants between the ages of 20 and 45, identified impairments in peak systolic strain and myocardial work—measures of how the heart muscle contracts and pumps blood. These abnormalities were observed even in the absence of clinical heart failure, suggesting an early stage of myocardial dysfunction linked to compromised coronary vascular function.
Researchers used the American Heart Association’s 17-segment model to assess regional heart function across areas supplied by the main coronary arteries. Their findings showed widespread impairment in the left ventricular segments of patients with bipolar disorder compared to individuals without psychiatric illness.
“This is the first study to evaluate regional peak systolic strain and myocardial work in bipolar disorder using this model,” said lead investigator Dr. Pao-Huan Chen, of Taipei Medical University. “Our goal was to identify early patterns that may explain the connection between bipolar disorder and heart disease.”
First author Dr. Cheng-Yi Hsiao, of Taipei Medical University Hospital, added, “While we knew patients with bipolar disorder face increased cardiovascular risk, it was striking to see such extensive myocardial dysfunction in a relatively young group of patients.”
Bipolar disorder, which typically begins in adolescence or early adulthood, is associated with a two-fold higher risk of heart failure compared with the general population. This contributes significantly to the nine- to 20-year reduction in life expectancy observed in these patients.
Experts suggest that incorporating measures of peak systolic strain and myocardial work into cardiovascular assessments for patients with bipolar disorder could allow earlier detection and management of heart dysfunction. Such monitoring may also inform new therapeutic strategies aimed at preventing heart failure and improving long-term health outcomes.
John Krystal, MD, editor of Biological Psychiatry, noted that the findings raise broader questions about the biological and environmental links between bipolar disorder and cardiovascular disease. “We need to understand the roles of genetics, psychotropic medications, lifestyle factors, and why women appear to be more affected than men,” he said.
The researchers emphasize that replication of these findings in larger and more diverse samples will be critical to advancing preventive strategies and therapies for this vulnerable population.
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