Differences in cholesterol and metabolic syndrome between bipolar disorder men with and without suicide attempts

Abstract

Patient with mental illnesses such as schizophrenia and bipolar disorder have an increased prevalence of metabolic syndrome (MetS) and its components compared to general population. Among psychiatric disorders, bipolar disorder ranks highest in suicidality with a relative risk ratio of completed suicide of about 25 compared to the general population.Regarding the biological hypotheses of suicidality, low blood cholesterol level has been extensively explored, although results are still conflicting. The aim of this study was to investigate whether there were differences in the serum cholesterol levels in hospitalized bipolar disorder men patients with history of suicide attempts (N=20) and without suicide attempts (N=20). Additionally, we investigated if there were differences in the prevalence of MetS according to NCEP ATP-III criteria in these two groups of patients. Results of the study indicated significantly lower serum cholesterol levels (p=0.013) and triglyceride levels (p=0.047), in the bipolar disorder men with suicide attempts in comparison to bipolar disorder men without suicide attempts. The overall prevalence of MetS was 11/40 (27.5%). On this particular sample it was higher in the non-attempters 8/20 (40.0%) than in attempters 3/20 (15.0%) bipolar men group, but without statistical significance. Lower concentrations of serum cholesterol might be useful biological markers of suicidality in men with bipolar disorder.

Serum triglycerides, but not cholesterol or leptin, are decreased in suicide attempters with mood disorders

“…However, since ours is a cross-sectional study, we cannot rule out that the use of anticonvulsant drugs, which were more prevalent in the non-attempter group, contributed to the discrepancy observed in BMI and serum triglyceride levels. In another study regarding BD, decreased cholesterol and triglycerides were observed in suicide attempters (Vuksan-Cusa et al, 2009). Interestingly, in Vuksan-Cusa's study the sample was free of psychotropic medication, reinforcing the idea that medication is not the sole contributor to changes in lipid profile.…”

Mania and mortality: Why the excess cardiovascular risk in bipolar disorder?

“…Patients with bipolar disorder and lower cholesterol levels have a higher burden of manic-but not depressive-symptoms, suggesting a possible relationship between low cholesterol and manic morbidity [41] without an expected increased risk for vascular disease. Low levels of cholesterol and triglycerides also have been associated with more frequent suicide attempts in individuals with bipolar disorder, whereas the presence of the metabolic syndrome has been associated with fewer attempts [42]. Meanwhile, high triglycerides and the metabolic syndrome may predispose individuals to vascular disease.…”

Potential neurochemical links between cholesterol and suicidal behavior

“…Zhang et al, 2005), case-control (e.g. Vuksan-Cusa et al, 2009) and cohort studies (e.g Boscarino et al, 2009). Among the few studies that differentiate the fractions of cholesterol, suicidal behavior and impulsivity have been associated with lower levels of low-density lipoprotein/cholesterol (Lee and Kim, 2003;Agargun et al, 2004;Garland et al, 2007;Marcinko et al, 2008), while low levels of high-density lipoprotein/cholesterol have been more strongly associated with depressive symptomatology (Troisi, 2009).…”