Asociación entre el trastorno afectivo bipolar y la enfermedad cardiovascular: una revisión narrativa
DOI:
https://doi.org/10.20453/rnp.v89i3.6828Palabras clave:
trastorno bipolar, factores de riesgo de enfermedad cardíaca, prevención de enfermedades, psicotrópicos, biomarcadoresResumen
Esta revisión tuvo como objetivo analizar la literatura reciente en torno a la asociación entre el trastorno afectivo bipolar (TAB) y el riesgo cardiovascular, así como su aplicabilidad clínica en el entorno sanitario. Se realizó una revisión bibliográfica mediante una búsqueda sistemática en la base de datos PubMed. La ventana de selección incluyó publicaciones fechadas entre los años 2022 y 2024, centradas en muestras de pacientes con diagnóstico de TAB y su correlación epidemiológica o fisiopatológica con eventos cardiovasculares. Se identificaron artículos que cubren cuatro aspectos sobre la relación bidireccional estudiada: base fisiopatológica común, potenciales biomarcadores, blancos terapéuticos comunes y oportunidades actuales de impacto. Se concluye que la literatura científica respalda de forma sólida la asociación bidireccional entre el TAB y el riesgo cardiovascular. La mayor oportunidad de impacto está dada por el tamizaje de riesgo cardiovascular en pacientes con TAB, con estrategias estandarizadas como el control de la presión arterial, la glucemia, el colesterol LDL, el índice de masa corporal, la prescripción de actividad física y el cese de consumo de alcohol, cigarrillos y sustancias psicoactivas.
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Nierenberg AA, Agustini B, Köhler-Forsberg O, et al. Diagnosis and treatment of bipolar disorder: a review. JAMA. 2023;330(14):1370-80. doi:10.1001/jama.2023.18588
Goldberg JF, DelBello MP, Swartz HA. Expanded treatment options and addressing unmet needs in the diagnosis and treatment of bipolar disorder. J Clin Psychiatry. 2022;83(6):MS21058AH5. doi:10.4088/JCP.MS21058AH5
Goes FS. Diagnosis and management of bipolar disorders. Br Med J. 2023;381:e073591. doi:10.1136/bmj-2022-073591
García-Jiménez J, Gómez-Sierra FJ, Martínez-Hortelano A, et al. Cigarette smoking and risk of suicide in bipolar disorder: a systematic review. Front Psychiatry. 2023;14:1179733. doi:10.3389/fpsyt.2023.1179733
Guillen-Burgos H, Moreno-Lopez S, Acevedo-Vergara K, et al. Risk of childhood trauma exposure and severity of bipolar disorder in Colombia. Int J Bipolar Disord. 2023;11(1):7. doi:10.1186/s40345-023-00289-5
Alzahrani H. Understanding quality of life in bipolar disorder: associated factors and coping strategies. Front Psychol. 2024;15:1484747. doi:10.3389/fpsyg.2024.1484747
Kessing LV, Ziersen SC, Andersen PK, et al. A nation-wide population-based longitudinal study mapping physical diseases in patients with bipolar disorder and their siblings. J Affect Disord. 2021;282:18-25. doi:10.1016/j.jad.2020.12.072
Ogasawara M, Takeshima M, Esaki Y, et al. Comparison of the efficacy and safety of quetiapine and lithium for bipolar depression: a systematic review and meta-analysis of randomized controlled trials. Neuropsychopharmacol Rep. 2022;42(4):410-20. doi:10.1002/npr2.12283
Veeneman RR, Vermeulen JM, Bialas M, et al. Mental illness and cardiovascular health: observational and polygenic score analyses in a population-based cohort study. Psychol Med. 2024;54(5):931-9. doi:10.1017/S0033291723002635
Najar H, Joas E, Pålsson E, et al. Time effect on cardiometabolic risk indicators in patients with bipolar disorder: a longitudinal case-control study. Eur Arch Psychiatry Clin Neurosci. 2023;273(5):1191-200. doi:10.1007/s00406-022-01520-7
Aguglia A, Salvi V, Amerio A, et al. Number of episodes and duration of illness associated with hypertension and 10-year cardiovascular risk in patients with bipolar disorder type I. Psychiatry Res. 2022;308:114344. doi:10.1016/j.psychres.2021.114344
Tsai SY, Kuo CJ, Sajatovic M, et al. Lithium exposure and chronic inflammation with activated macrophages and monocytes associated with atherosclerosis in bipolar disorder. J Affect Disord. 2022;314:233-40. doi:10.1016/j.jad.2022.07.024
Shah D, Singh B, Varnika FN, et al. Linking hearts and minds: understanding the cardiovascular impact of bipolar disorder. Future Cardiol. 2024;20(13):709-18. doi:10.1080/14796678.2024.2408944
Mosolov SN, Fedorova EY. The risk of developing cardiovascular disease in bipolar disorder. Biological factors and therapy. Ter Arkh. 2022;94(4):579-83. doi:10.26442/00403660.2022.04.201455
Hiller JK, Jangmo A, Tesli MS, et al. Lipid biomarker research in bipolar disorder: a scoping review of trends, challenges, and future directions. Biol Psychiatry Glob Open Sci. 2023;3(4):594-604. doi:10.1016/j.bpsgos.2023.07.004
Shickh R, Mio M, Khoubaeva D, et al. Exercise preference and tolerance in youth with bipolar disorder. J Psychosom Res. 2023;165:111013. doi:10.1016/j.jpsychores.2022.111013
McCartan CJ, Yap J, Best P, et al. Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence. Cochrane Database Syst Rev. 2024;(6):CD013557. doi:0.1002/14651858.CD013557.pub2
Knedeisen F, Stapel B, Heitland I, et al. Cardiovascular risk in bipolar disorder - A case for the hypothalamus-pituitary-adrenal axis? J Affect Disord. 2023;324:410-7. doi:10.1016/j.jad.2022.12.072
Paljärvi T, Herttua K, Taipale H, et al. Cardiovascular mortality in bipolar disorder: population-based cohort study. Acta Psychiatr Scand. 2024;150(2):56-64. doi:10.1111/acps.13715
Foroughi M, Medina JR, Lopez-Jimenez F, et al. Association of Bipolar disorder with major adverse cardiovascular events: a population-based historical cohort study. Psychosom Med. 2022;84(1):97-103. doi:10.1097/PSY.0000000000001017
Ortiz A, Sanches M, Abdelhack M, et al. Sex-specific associations between lifetime diagnosis of bipolar disorder and cardiovascular disease: a cross-sectional analysis of 257,673 participants from the UK Biobank. J Affect Disord. 2022;319:663-9. doi:10.1016/j.jad.2022.09.048
Rossom RC, Hooker SA, O’Connor PJ, et al. Cardiovascular risk for patients with and without schizophrenia, schizoaffective disorder, or bipolar disorder. J Am Heart Assoc. 2022;11(6):e021444. doi:10.1161/JAHA.121.021444
Reponen EJ, Ueland T, Rokicki J, et al. Polygenic risk for schizophrenia and bipolar disorder in relation to cardiovascular biomarkers. Eur Arch Psychiatry Clin Neurosci. 2024;274(5):1223-30. doi:10.1007/s00406-023-01591-0
Kılıçaslan AK, Emir BS, Yildiz S, et al. Arterial Stiffness in patients with bipolar disorder. Clin Psychopharmacol Neurosci. 2023;21(3):516-25. doi:10.9758/cpn.22.1009
Kennedy KG, Ghugre NR, Roifman I, et al. Impaired coronary microvascular reactivity in youth with bipolar disorder. Psychol Med. 2024;54(6):1196-206. doi:10.1017/S0033291723003021
Goldstein B, Kennedy KG, Karthikeyan S, et al. Endothelial function in youth with bipolar disorder: preliminary evidence for mood polarity differences. J Clin Psychiatry. 2023;84(3):22m14608. doi:http://doi.org/10.4088/JCP.22m14608
Bøgh HL, Stanislaus S, Kjærstad HL, et al. Associations between levels of oxidative nucleoside damage and cardiovascular risk in patients newly diagnosed with bipolar disorder and their unaffected relatives. Transl Psychiatry. 2022;12:327. doi:10.1038/s41398-022-02095-6
Chen PH, Chang CK, Lin YK, et al. Association of circulating monocyte number and monocyte-lymphocyte ratio with cardiovascular disease in patients with bipolar disorder. BMC Psychiatry. 2024;24:679. doi:10.1186/s12888-024-06105-3
Corponi F, Li BM, Anmella G, et al. A Bayesian analysis of heart rate variability changes over acute episodes of bipolar disorder. npj Ment Health Res. 2024;3:44. doi:10.1038/s44184-024-00090-x
Kuperberg M, Köhler-Forsberg O, Shannon AP, et al. Cardiometabolic risk markers during mood-stabilizing treatment: correlation with drug-specific effects, depressive symptoms and treatment response. J Affect Disord. 2022;300:41-9. doi:10.1016/j.jad.2021.12.047
Lintunen J, Lähteenvuo M, Tanskanen A, et al. Allopurinol, dipyridamole and calcium channel blockers in the treatment of bipolar disorder - A nationwide cohort study. J Affect Disord. 2022;313:43-8. doi:10.1016/j.jad.2022.06.040
Carnovale C, Perrotta C, Baldelli S, et al. Antihypertensive drugs and brain function: mechanisms underlying therapeutically beneficial and harmful neuropsychiatric effects. Cardiovasc Res. 2023;119(3):647-67. doi:10.1093/cvr/cvac110
Gill H, Rodrigues NB, Mansur RB, et al. The effect of adjunctive infliximab treatment on future cardiovascular disease risk in patients with bipolar disorder. J Affect Disord. 2022;316:273-9. doi:10.1016/j.jad.2022.07.020
Croatto G, Vancampfort D, Miola A, et al. The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: an umbrella review of the evidence from randomised controlled trials. Mol Psychiatry. 2023;28:369-90. doi:10.1038/s41380-022-01770-w
Polcwiartek C, O’Gallagher K, Friedman DJ, et al. Severe mental illness: cardiovascular risk assessment and management. Eur Heart J. 2024;45(12):987-97. doi:10.1093/eurheartj/ehae054
Vancampfort D, Mugisha J, Van Damme T. The Physical Activity Vital Sign and associations with cardiometabolic risks in people with bipolar disorder in a low-income country. J Affect Disord. 2023;339:763-6. doi:10.1016/j.jad.2023.07.090
Gomes-da-Costa S, Fernandéz-Pérez I, Borras R, et al. Is a vegetarian diet beneficial for bipolar disorder? Relationship between dietary patterns, exercise and pharmacological treatments with metabolic syndrome and course of disease in bipolar disorder. Acta Psychiatr Scand. 2024;150(4):209-22. doi:10.1111/acps.13733
Rossom RC, Crain AL, Waring S, et al. Differential effects of an intervention to reduce cardiovascular risk for patients with bipolar disorder, schizoaffective disorder, or schizophrenia: a randomized clinical trial. J Clin Psychiatry. 2023;84(4):22m14710. doi:10.4088/JCP.22m14710
Pahwa M, Kucuker MU, Ho MC, et al. Cardiometabolic and endocrine comorbidities in women with bipolar disorder: a systematic review. J Affect Disord. 2023;323:841-59. doi:10.1016/j.jad.2022.12.023
Etxaniz-Oses J, Maldonado-Martín S, Zorrilla I, et al. Are adults with bipolar disorder at increased cardiovascular risk due to their physical, biochemical, and physiological profiles? The FINEXT-BD study. Brain Behav. 2025;15(2):e70297. doi:10.1002/brb3.70297
Levin JB, Moore DJ, Depp C, et al. Using mHealth to improve adherence and reduce blood pressure in individuals with hypertension and bipolar disorder (iTAB-CV): study protocol for a 2-stage randomized clinical trial. Trials. 2022;23:539. doi:10.1186/s13063-022-06449-9
Bosi A, Ceriani L, Elinder CG, et al. Quality of laboratory biomarker monitoring during treatment with lithium in patients with bipolar disorder. Bipolar Disord. 2023;25(6):499-506. doi:10.1111/bdi.13302
American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025. Diabetes Care. 2025;48(suppl 1):S27-49. doi:10.2337/dc25-S002
Fontaine J, Chin E, Provencher JF, et al. Assessing cardiometabolic parameter monitoring in inpatients taking a second-generation antipsychotic: the CAMI-SGA study - A cross-sectional study. BMJ Open. 2022;12(4):e055454. doi:10.1136/bmjopen-2021-055454
Hsueh L, Iturralde E, Slama NE, et al. Cardiometabolic monitoring and sociodemographic and clinical characteristics of youths prescribed antipsychotic medications. Psychiatr Serv. 2023;74(8):801-8. doi:10.1176/appi.ps.20220151
Pietschnig J, Oberleiter S, Köhler MD. Smoking behavior is associated with suicidality in individuals with psychosis and bipolar disorder: a systematic quantitative review and meta-analysis. Front Psychol. 2024;15:1369669. doi:10.3389/fpsyg.2024.1369669
He M, Zhou J, Li X, et al. Investigating the causal effects of smoking, sleep, and BMI on major depressive disorder and bipolar disorder: a univariable and multivariable two-sample Mendelian randomization study. Front Psychiatry. 2023;14:1206657. doi:10.3389/fpsyt.2023.1206657
Liou YJ, Wang TY, Lee SY, et al. Effects of comorbid alcohol use disorder on bipolar disorder: focusing on neurocognitive function and inflammatory markers. Psychoneuroendocrinology. 2023;152:106083. doi:10.1016/j.psyneuen.2023.106083
Martyn FM, McPhilemy G, Nabulsi L, et al. Alcohol use is associated with affective and interoceptive network alterations in bipolar disorder. Brain Behav. 2023;13(1):e2832. doi:10.1002/brb3.2832
De Carlo V, Grancini B, Cassina N, et al. Cardiovascular risk factors and metabolic syndrome in patients treated with long-acting injectables antipsychotics: a retrospective study. Int Clin Psychopharmacol. 2023;38(3):160-8. doi:10.1097/YIC.0000000000000448
Chen J, Duan W, Liu P, et al. Schizophrenia, bipolar disorder and major depressive disorder are probably not risk factors for cardiovascular disease: a Mendelian randomized study. J Affect Disord. 2025;377:184-96. doi:10.1016/j.jad.2025.02.069
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Derechos de autor 2026 Mateo López Trujillo, Juan David Quintero Bonilla, Valentina de Alba Higuita, Pedro Vallejo Ramírez, Isabel Calle Ortiz, Juan Camilo Suárez Escudero

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.















