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Риск развития сердечно-сосудистых заболеваний при биполярном расстройстве. Биологические факторы и терапия
DOI: 10.26442/00403660.2022.04.201455
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Mosolov SN, Fedorova EYu. The risk of developing cardiovascular disease in bipolar disorder. Biological factors and therapy. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(4):579–583. DOI: 10.26442/00403660.2022.04.201455
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Материалы и методы. Проведена выборочная оценка существующих на данный момент исследований, сфокусированных на патофизиологической взаимосвязи БР и ССЗ. Поиск проводился в базах PubMed и eLIBRARY по следующим ключевым словам: bipolar disorder, psychopharmacology, cardiovascular disease, biological mediators.
Результаты. Существует несколько биологических факторов, подтверждающих наличие общих патогенетических звеньев при БР и ССЗ. Наибольший интерес из них представляют такие биологические маркеры, как воспаление, оксидативный стресс и мозговой нейротрофический фактор. Нейровизуализационные методы также показали близкие структурные изменения головного мозга при БР и ССЗ. Имеются данные об эффективности применения статинов и ингибиторов ангиотензинпревращающего фермента у больных с БР для снижения сердечно-сосудистых факторов риска.
Обсуждение. При БР имеется повышенная предрасположенность к развитию ССЗ. Необходимо учитывать особенности течения БР и проводить активный мониторинг и профилактические мероприятия для снижения риска развития жизнеугрожающих ССЗ. Необходимо проведение дальнейших исследований для поиска биологических факторов риска, общих для БР и ССЗ.
Ключевые слова: биполярное расстройство, сердечно-сосудистые заболевания, биологические маркеры, окислительный стресс, воспаление, нейротрофический фактор головного мозга
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Background. Bipolar disorder (BD) is one of the most common mental disorders characterized by alternating episodes of mania/hypomania and depression, as well as the possibility of developing mixed conditions. Correct and timely diagnosis of BD is important due to the presence of a high suicidal risk and a high predisposition to the development of cardiovascular disease (CVD). The risk of CVD is higher in ВD than in other mental disorders.
Materials and methods. A sample assessment was made of current studies focusing on the vascular-bipolar link. The search was carried out in the PubMed and eLIBRARY databases for the following keywords: bipolar disorder, psychopharmacology, cardiovascular disease, biological mediators.
Results. There are several biological factors which explain the close association and common pathogenetic mechanisms of BD and CVD. The most interesting of them are inflammation, oxidative stress, and brain-derived neurotrophic factor. Neuroimaging methods have shown similar structural brain changes in people with BD and with CVD. There is some evidence of the efficacy of statins and angiotensin-converting enzyme inhibitors in reducing cardio-vascular risk factors in BD patients.
Conclusion. The predisposition of patients of BD to CVD is beyond doubt. It is necessary to consider the peculiarities of the course of BD and conduct active monitoring and preventive measures to reduce the risk of developing life-threatening CVDs. Further research focused on the pathogenetic relationship between BD and CVD could provide more insight into this area.
Keywords: bipolar disorder, cardiovascular diseases, biological markers, oxidative stress, inflammation, brain-derived neurotrophic factor
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3. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64(2):161-74.
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8. Mosolov SN, Ushkalova AV, Kostyukova EG, et al. Validation of the Russian version of the hypomania checklist (HCL-32) for the detection of bipolar II disorder in patients with a current diagnosis of recurrent depression. J Affect Disord. 2014;155(1):90-5. DOI:10.1016/j.jad.2013.10.029
9. Osby U, Westman J, Hallgren J, et al. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987-2010. Eur J Public Health. 2016;26:867-71. DOI:10.1093/eurpub/ckv245
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21. Andreazza AC, Shao L, Wang J-F, et al. Mitochondrial complex I activity and oxidative damage to mitochondrial proteins in the prefrontal cortex of patients with bipolar disorder mitochondrial dysfunction and oxidative stress. Arch Gen Psychiatry. 2010;67:360-8. DOI:10.1001/archgenpsychiatry.2010.22
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29. Smith EE. Leukoaraiosis and stroke. Stroke. 2010;41:S139-43. DOI:10.1161/STROKEAHA.110.596056
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1. Psikhiatriia: natsional'noe rukovodstvo. Kratkoe izdanie. Pod red. TB Dmitrievoi, NG Neznanova, UA Aleksandrovskogo. Moscow, Geotar Medicina. 2012 (in Russian).
2. Lish JD, Dime-Meenan S, Whybrow PC, et al. The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord. 1994;31(4):281-94. DOI:10.1016/0165-0327(94)90104-X
3. Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64(2):161-74.
4. Angst J, Azorin JM, Bowden CL, et al. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: The BRIDGE study. Arch Gen Psychiatry. 2011. 68(8):791-8. DOI:10.1001/archgenpsychiatry.2011.87
5. Mosolov S, Ushkalova A, Kostyukova E, et al. Bipolar II disorder in patients with a current diagnosis of recurrent depression. Bipolar Disord. 2014;16(4):389-99. DOI:10.1111/bdi.12192
6. Angst J, Adolfsson R, Benazzi F, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord. 2005;88:217-33. DOI:10.1016/j.jad.2005.05.0111.
7. Solomon DA, Leon AC, Maser JD, et al. Distinguishing bipolar major depression from unipolar major depression with the screening assess-ment of depression-polarity (SAD-P). J Clin Psychiatry. 2006;67(3):434-42. DOI:10.4088/JCP.v67n0315
8. Mosolov SN, Ushkalova AV, Kostyukova EG, et al. Validation of the Russian version of the hypomania checklist (HCL-32) for the detection of bipolar II disorder in patients with a current diagnosis of recurrent depression. J Affect Disord. 2014;155(1):90-5. DOI:10.1016/j.jad.2013.10.029
9. Osby U, Westman J, Hallgren J, et al. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987-2010. Eur J Public Health. 2016;26:867-71. DOI:10.1093/eurpub/ckv245
10. Goldstein BI, Fagiolini A, Houck P, et al. Cardiovascular disease and hypertension among adults with bipolar I disorder in the United States. Bipolar Disord. 2009;11:657-62. DOI:10.1111/j.1399-5618.2009.00735.x
11. Mosolov SN, Fedorova EYu. The risk of developing cardiovascular disease in bipolar disorder. Clinical and social factors. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(12):1556-61 (in Russian). DOI:10.26442/00403660.2021.12.201175
12. Petrova NN, Maiorova MA. The Role of Kynurenine Pathway in Development and Therapy of Depression. Current Therapy of Mental Disorders. 2018;4:2-7 (in Russian). DOI:10.21265/PSYPH.2018.47.21771
13. Goldstein BI, Young LT. Toward clinically applicable biomarkers in bipolar disorder: focus on BDNF, inflammatory markers, and endothelial function. Curr Psychiatry Rep. 2013;15:425. DOI:10.1007/s11920-013-0425-9
14. Brietzke E, Stertz L, Fernandes BS, et al. Comparison of cytokine levels in depressed, manic and euthymic patients with bipolar disorder. J Affect Disord. 2009;116:214-7. DOI:10.1016/j.jad.2008.12.001
15. Munkholm K, Vinberg M, Vedel Kessing L. Cytokines in bipolar disorder: a systematic review and meta-analysis. J Affect Disord. 2013;144:16-27. DOI:10.1016/j.jad.2012.06.010
16. Buckley DI, Fu R, Freeman M, et al. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:483-95. DOI:10.7326/0003-4819-151-7-200910060-00009
17. Kattoor AJ, Pothineni NVK, Palagiri D, et al. Oxidative Stress in Atherosclerosis. Curr Atheroscler Rep. 2017;19:42. DOI:10.1007/s11883-017-0678-6
18. Forstermann U, Xia N, Li H. Roles of Vascular Oxidative Stress and Nitric Oxide in the Pathogenesis of Atherosclerosis. Circ Res. 2017;120:713-35. DOI:10.1161/CIRCRESAHA.116.309326
19. Incalza MA, D'Oria R, Natalicchio A, et al. Oxidative stress and reactive oxygen species in endothelial dysfunction associated with cardiovascular and metabolic diseases. Vascul Pharmacol. 2018;100:1-19. DOI:10.1016/j.vph.2017.05.005
20. Huggins GS. Genetic Susceptibility to Oxidative Stress and Cardiovascular Disease. EBioMedicine. 2015;2:1864-5. DOI:10.1016/j.ebiom.2015.11.042
21. Andreazza AC, Shao L, Wang J-F, et al. Mitochondrial complex I activity and oxidative damage to mitochondrial proteins in the prefrontal cortex of patients with bipolar disorder mitochondrial dysfunction and oxidative stress. Arch Gen Psychiatry. 2010;67:360-8. DOI:10.1001/archgenpsychiatry.2010.22
22. Wang J-F, Shao L, Sun X, et al. Increased oxidative stress in the anterior cingulate cortex of subjects with bipolar disorder and schizophrenia. Bipolar Disord. 2009;11:523-9. DOI:10.1111/j.1399-5618.2009.00717.x
23. Jin H, Chen Y, Wang B, et al. Association between brain-derived neurotrophic factor and von Willebrand factor levels in patients with stable coronary artery disease. BMC Cardiovasc Disord. 2018;18:23. DOI:10.1186/s12872-018-0762-z
24. Kaess BM, Preis SR, Lieb W, et al. Circulating Brain-derived Neurotrophic Factor Concentrations and the Risk of Cardiovascular Disease in the Community. J Am Heart Assoc. 2015;4:e001544. DOI:10.1161/JAHA.114.001544
25. Alomari MA, Khabour OF, Maikano A, et al. Vascular function and brain-derived neurotrophic factor: The functional capacity factor. Vasc Med. 2015;20:518-26. DOI:10.1177/1358863X15598390
26. Donovan MJ, Lin MI, Wiegn P, et al. Brain derived neurotrophic factor is an endothelial cell survival factor required for intramyocardial vessel stabilization. Development. 2000;127:4531-40. DOI:10.1242/dev.127.21.4531
27. Matsuo K, Walss-Bass C, Nery FG, et al. Neuronal correlates of brain-derived neurotrophic factor Val66Met polymorphism and morphometric abnormalities in bipolar disorder. Neuropsychopharmacology. 2009;34:1904‑13. DOI:10.1038/npp.2009.23
28. Fernandes BS, Gama CS, Cereser KM, et al. Brain-derived neurotrophic factor as a state-marker of mood episodes in bipolar disorders: a systematic review and meta-regression analysis. J Psychiatr Res. 2011;45:995-1004. DOI:10.1016/j.jpsychires.2011.03.002
29. Smith EE. Leukoaraiosis and stroke. Stroke. 2010;41:S139-43. DOI:10.1161/STROKEAHA.110.596056
30. Beyer JL, Young R, Kuchibhatla M, et al. Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review. Int Rev Psychiatry. 2009;21:394-409. DOI:10.1080/09540260902962198
31. Bond DJ, Ha TH, Lang DJ, et al. Body mass index-related regional gray and white matter volume reductions in first-episode mania patients. Biol Psychiatry. 2014;76:138-45. DOI:10.1016/j.biopsych.2013.08.030
32. Kuswanto CN, Sum MY, Yang GL, et al. Increased body mass index makes an impact on brain white-matter integrity in adults with remitted first-episode mania. Psychol Med. 2014;44:533-41. DOI:10.1017/S0033291713000858
33. Bond DJ, Su W, Honer WG, et al. Weight gain as a predictor of frontal and temporal lobe volume loss in bipolar disorder: A prospective MRI study. Bipolar Disord. 2019;21:50-60. DOI:10.1111/bdi.12722
34. Shi Y, Thrippleton MJ, Makin SD, et al. Cerebral blood flow in small vessel disease: A systematic review and meta-analysis. J Cereb Blood Flow Metab. 2016;36:1653-67. DOI:10.1177/0271678X16662891
35. Toma S, MacIntosh BJ, Swardfager W, et al. Cerebral blood flow in bipolar disorder: A systematic review. J Affect Disord. 2018;241:505-13. DOI:10.1016/j.jad.2018.08.040
36. Bhardwaj R, Chakrabarti S, Mittal BR, et al. A single photon emission computerized tomography (SPECT) study of regional cerebral blood flow in bipolar disorder. World J Biol Psychiatry. 2010;11:334-43. DOI:10.3109/15622970802575977
37. Zhao L, Wang Y, Jia Y, et al. Microstructural Abnormalities of Basal Ganglia and Thalamus in Bipolar and Unipolar Disorders: A Diffusion Kurtosis and Perfusion Imaging Study. Psychiatry Investig. 2017;14:471-82. DOI:10.4306/pi.2017.14.4.471
38. Kruger S, Alda M, Young LT, et al. Risk and resilience markers in bipolar disorder: brain response to emotional challenge in bipolar patients and their healthy siblings. Am J Psychiatry. 2006;163:257-64. DOI:10.1176/appi.ajp.163.2.257
39. Almeida JR, Mourao-Miranda J, Aizenstein HJ, et al. Pattern recognition analysis of anterior cingulate cortex blood flow to classify depression polarity. Br J Psychiatry. 2013;203:310-1. DOI:10.1192/bjp.bp.112.122838
40. Kim SW, Kang HJ, Bae KY, et al. Interactions between proinflammatory cytokines and statins on depression in patients with acute coronary syndrome. Prog Neuropsychopharmacol Biol Psychiatry. 2018;80:250-4. DOI:10.1016/j.pnpbp.2017.07.003
41. Persons JE, Robinson JG, Payne ME, et al. Serum lipid changes following the onset of depressive symptoms in postmenopausal women. Psychiatry Res. 2017;247:282-7. DOI:10.1016/j.psychres.2016.12.006
42. Salagre E, Fernandes BS, Dodd S, et al. Statins for the treatment of depression: A meta-analysis of randomized, double-blind, placebo-controlled trials.
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1 Московский научно-исследовательский институт психиатрии – филиал ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии имени В.П. Сербского» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*profmosolov@mail.ru
________________________________________________
Sergey N. Mosolov*1,2, Elizaveta Yu. Fedorova1
1 Moscow Research Institute of Psychiatry – a branch of the Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*profmosolov@mail.ru