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Experts urge early monitoring for heart disease in teens with mood disorders

Aug 10, 2015

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A mood disorder in adolescence is a risk factor for heart disease in adulthood, suggests an American Heart Association scientific statement recommending its addition to cardiovascular risk reduction and prevention guidelines.

“Teenagers with mood disorders are at increased risk for premature heart disease and clinicians have an opportunity to reduce this risk through assertive screening and treatment of traditional heart disease risk factors,” says Dr. Benjamin Goldstein, lead author of the statement and Director of the Centre for Youth Bipolar Disorder at Sunnybrook, who advocated that mood disorders should be added to a list of four previously-identified moderate risk conditions.

Ten percent of adolescents in the United States have a mood disorder, making these conditions at least 10 times more common than the four existing cardiovascular moderate risk conditions combined, which range from 0.5 to less than 0.05 percent each.

The authors reviewed existing literature and provide evidence that youth mood disorders, namely major depressive disorder and bipolar disorder, meet the criteria for moderate-risk conditions associated with increased and premature cardiovascular risk (or accelerated heart disease).

“There were alarm bells going off,” says Goldstein, a child-adolescent psychiatrist and researcher whose work is now focused on the causes and prevention of cardiovascular risk among adolescents with or at risk for bipolar disorder, commenting on missed opportunities for cardiovascular risk reduction. “We can’t allow the mood symptoms that define these disorders to distract us from the fact that these disorders also confer meaningfully increased risk of heart disease that requires increased vigilance and action from the earliest possible juncture.”

Excess and premature cardiovascular disease (CVD) mortality in bipolar disorder has been documented for over 70 years, prior to the use of mood stabilizers and antipsychotics.

“The strength of association between mood disorders and CVD warranted the need for this statement to address CVD risk among this adolescent population,” says Dr. Goldstein. “Mood disorders are often lifelong conditions, and managing cardiovascular risk early and assertively is tremendously important if we are to be successful in ensuring that the next generation of youth has better cardiovascular outcomes in adulthood than what we’re seeing currently. More research is needed, to provide a better understanding of the biology that underlies the increased cardiovascular risk among people with mood disorders.”

Integrating mental healthcare with primary healthcare (provided by a family physician or nurse practitioner) is a key component shown to be more effective than siloed approaches.

“Heart-healthy living is important for all youth, but it is especially important for youth with mood disorders,” adds Goldstein. “The topics of nutrition, physical activity, sleep, and smoking need to be front and centre. The potential consequences of having mental and physical healthcare for youth in parallel, rather than integrated, universes includes having another generation of adults with mood disorders whose lives are cut short by cardiovascular disease.”

The authors suggest the success of this statement will rely on the extent to which it results in improved CVD risk factor screening, prevention, and intervention among adolescents and young adults with mood disorders, and the extent to which it spurs increased collaboration between preventive cardiology, pediatrics, and psychiatry, together with consumers and other stakeholders, in achieving these goals. “If this position is implemented as intended, a large number of youth will come under the radar for risk of early heart disease, spurring concerted action by patients, families, healthcare providers and policymakers.”

Dr. Benjamin Goldstein

Full media release

Mood disorders among youth increase heart disease risk

August 10, 2015 (Toronto, ON) – A mood disorder in adolescence is a risk factor for heart disease in adulthood, suggests an American Heart Association scientific statement recommending its addition to cardiovascular risk reduction and prevention guidelines.

“Teenagers with mood disorders are at increased risk for premature heart disease and clinicians have an opportunity to reduce this risk through assertive screening and treatment of traditional heart disease risk factors,” says Dr. Benjamin Goldstein, lead author of the statement and Director of the Centre for Youth Bipolar Disorder at Sunnybrook Health Sciences Centre, who advocated that mood disorders should be added to a list of four previously-identified moderate risk conditions.

Ten percent of adolescents in the United States have a mood disorder, making these conditions at least 10 times more common than the four existing cardiovascular moderate risk conditions combined, which range from 0.5 to less than 0.05 percent each.

In the scientific statement, published in the highest-impact cardiology journal Circulation, the authors reviewed existing literature and provide evidence that youth mood disorders, namely major depressive disorder and bipolar disorder, meet the criteria for moderate-risk conditions associated with increased and premature cardiovascular risk (or accelerated heart disease).

“There were alarm bells going off,” says Goldstein, a child-adolescent psychiatrist and researcher whose work is now focused on the causes and prevention of cardiovascular risk among adolescents with or at risk for bipolar disorder, commenting on missed opportunities for cardiovascular risk reduction. “We can’t allow the mood symptoms that define these disorders to distract us from the fact that these disorders also confer meaningfully increased risk of heart disease that requires increased vigilance and action from the earliest possible juncture.”

Excess and premature cardiovascular disease (CVD) mortality in bipolar disorder has been documented for over 70 years, prior to the use of mood stabilizers and antipsychotics.

“The strength of association between mood disorders and CVD warranted the need for this statement to address CVD risk among this adolescent population,” says Dr. Goldstein, also an Associate Professor of Psychiatry, Pharmacology, and Psychological Clinical Science at University of Toronto. “Mood disorders are often lifelong conditions, and managing cardiovascular risk early and assertively is tremendously important if we are to be successful in ensuring that the next generation of youth has better cardiovascular outcomes in adulthood than what we’re seeing currently. More research is needed, to provide a better understanding of the biology that underlies the increased cardiovascular risk among people with mood disorders.”

Integrating mental healthcare with primary healthcare (provided by a family physician or nurse practitioner) is a key component shown to be more effective than siloed approaches.

“Heart-healthy living is important for all youth, but it is especially important for youth with mood disorders,” adds Goldstein. “The topics of nutrition, physical activity, sleep, and smoking need to be front and centre. The potential consequences of having mental and physical healthcare for youth in parallel, rather than integrated, universes includes having another generation of adults with mood disorders whose lives are cut short by cardiovascular disease.”

The authors suggest the success of this statement will rely on the extent to which it results in improved CVD risk factor screening, prevention, and intervention among adolescents and young adults with mood disorders, and the extent to which it spurs increased collaboration between preventive cardiology, pediatrics, and psychiatry, together with consumers and other stakeholders, in achieving these goals. “If this position is implemented as intended, a large number of youth will come under the radar for risk of early heart disease, spurring concerted action by patients, families, healthcare providers and policymakers.”

The authors of the AHA scientific statement are experts in the fields of mood disorders, cardiovascular disease and pediatrics, and a community volunteer representing the patient perspective.

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Media contact:

Nadia Norcia Radovini

416.480.4040

nadia.radovini@sunnybrook.ca

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