In the 2011 publication “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents,” several medical conditions among youth were identified that predispose them to accelerated atherosclerosis and early cardiovascular disease (CVD), elaborating on risk stratification and management strategies for youth with these conditions. Based on this document, major depressive disorder (MDD) and bipolar disorder (BD) among the youth satisfy criteria and merit inclusion among Expert Panel tier II moderate-risk conditions. This new statement recommends that Major Depression and Bipolar Disorder should be considered as moderate risk factors for cardiovascular diseases.
Specifically, moderate-risk conditions are those for which “the disease process has been shown to be associated with pathologic, physiologic, or subclinical evidence of accelerated atherosclerosis. The statement is based recent evidence that reports cardiovascular events such as heart attacks and deaths among young people.
“Youth with mood disorders are not yet widely recognized as a group at increased risk for excessive and early heart disease. We hope these guidelines will spur action from patients, families and healthcare providers to reduce the risk of cardiovascular disease among these youth,” said Benjamin I. Goldstein, M.D., Ph.D., lead author of the statement and a child-adolescent psychiatrist at Sunnybrook Health Sciences Centre and the University of Toronto, in Toronto, Ontario, Canada.
Major depression and bipolar disorder affect approximately 10% of young people in the United States, with studies showing that adults with major depression and bipolar disorder are at increased risk for cardiovascular disease, and that they experience cardiovascular disease at much earlier ages than other adults. Because cardiovascular disease may begin early in life, this statement includes young people with the major depression and bipolar disorder as moderate-risk conditions for early cardiovascular disease.
Results from a systematic review conducted by the authors showed that young people with these mood disorders have cardiovascular disease risk factors such as: high cholesterol; type 2 diabetes; obesity, especially around the midsection; high blood pressure; and hardening of the arteries.
According to the authors, the underlying causes of these increased risks remain poorly understood, but studies have shown that they could be associated with inflammation and other types of cell damage. In these studies, young people with mood disorders were found to be at increased risk of having unhealthy behaviors such as smoking, being physically inactive and abusing drugs. However, these risk factors alone do not explain the increased risk for cardiovascular disease. Medications also do not explain the increased risk.
Based on these findings, the authors of the statement recommend the inclusion of major depression and bipolar disorder as a moderate risk factor for cardiovascular disease in young people.
“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,” Goldstein said. “These disorders indicate an increased risk of heart disease that requires increased vigilance and action at the earliest possible stage.”