Homocysteine and other markers of cardiovascular risk during a manic episode in patients with bipolar disorder

Abstract

Objective: To evaluate serum levels of different biomarkers associated with cardiovascular disease in patients with bipolar disorder (BD). Patients were prospectively evaluated in two separate instances: during acute mania and after remission of manic symptoms. All measurements were compared with those of healthy controls. Methods: The study included 30 patients with BD and 30 healthy controls, matched for gender and age. Biochemical parameters evaluated included homocysteine (Hcy), folic acid, vitamin B12, ferritin, creatine kinase (CK) and C-reactive protein (CRP). Results: Hcy levels were significantly higher in the BD patients, both during mania and after achieving euthymia. When Hcy was adjusted for body mass index, there was no significant difference between patients and controls. Ferritin was the only marker that showed a significant decrease during mania when compared to both euthymic patients and controls. There were no significant differences for folate, vitamin B12, CK and CRP. Conclusions: These findings do not show an association between alterations of markers of cardiovascular risk during manic episodes. Further studies are necessary to determine factors and mechanisms associated with cardiovascular risk in patients with BD.

Sex differences in the prevalence and clinical correlates of hyperhomocysteinemia in patients with bipolar disorder

“…In this study, BD patients had significantly higher prevalence of HHcy and greater plasma Hcy levels, which was consistent with the majority of previous studies assessing HHcy (Ezzaher et al, 2011;Permoda-Osip et al, 2013) and detecting Hcy levels in acute bipolar depressive episode (Chiarani et al, 2013;Salagre et al, 2017) and in remission (Chiarani et al, 2013;Dittmann et al, 2007) of BD. Furthermore, we found sex differences in HHcy rates and Hcy concentrations in BD patients, which was in agreement with previous studies showing elevated Hcy levels and HHcy rates in male patients compared with both their corresponding healthy controls and female patients; however, no significant difference was noted between BD women and female controls (Levine, Sela, Osher, & Belmaker, 2005;Osher et al, 2004;Permoda-Osip et al, 2013;Permoda-Osip et al, 2014).…”

“…Peripheral homocysteine (Hcy) has been considered as a potential biomarker for bipolar disorder (BD; Ghanizadeh, Singh, Berk, & Torabi‐Nami, ; Salagre et al, ). BD patients with hyperhomocysteinemia (HHcy) usually show abnormally high levels of Hcy in the blood (Chiarani et al, ; Dittmann et al, ; Osher, Bersudsky, Silver, Sela, & Belmaker, ; Osher, Sela, Levine, & Belmaker, ), which could increase the risk of cardiovascular disease (Chiarani et al, ). Some previous review articles have repeatedly described sex differences in prevalence, symptom characteristics, and disease outcome in BD (Baskaran, Cha, Powell, Jalil, & McIntyre, ; Bauer, Glenn, Pilhatsch, Pfennig, & Whybrow, ; Gogos, Ney, Seymour, Van Rheenen, & Felmingham, ; Jogia, Dima, & Frangou, ).…”

The search for mediators of vascular mortality with mania

“…1 Large, epidemiological studies have consistently found an increased risk of cardiovascular mortality in bipolar disorder, approximately twice that expected on the basis of age and gender. 2 This risk is higher in bipolar I disorder, which conveys a greater burden of manic and hypomanic symptomatology, than in bipolar II disorder.…”

“…1 No biomarkers associated with cardiovascular risk were associated with mania, apart from reductions in ferritin, an acute phase reactant. It is not clear how to interpret this finding.…”

“…The study design used by Chiarani et al 1 may serve as a template to survey state-and trait-dependent variables which may mediate risk of vascular disease. It is further important to mind the authors' concluding message: integrated medical and psychiatric care is needed to clinically address the medical comorbidities frequently present in those with bipolar disorder.…”