MACE, stroke, death common after acute coronary syndrome in people with bipolar disorder

In people with bipolar disorder (BD), major adverse cardiovascular events (MACE) are common occurrences after acute coronary syndrome (ACS), a new study has found. Similarly, the risks of all-cause mortality and stroke are also increased post-ACS.

Drawing from a Danish registry, researchers assessed 796 BD patients with ACS, in whom the likelihood of the primary outcome of a MACE composite was compared against 1,592 non-BD ACS controls. In both groups, the first ACS episode occurred at a mean age of 66.5 years. The MACE composite components—all-cause mortality, reinfarction, and stroke—were also compared between groups.

Overall, MACE risk was increased by nearly 40 percent in the BD group (hazard ratio [HR], 1.38, 95 percent confidence interval [CI], 1.25–1.54), as assessed by Cox proportional hazards models.

Such an effect was driven by all-cause mortality (HR, 1.71, 95 percent CI, 1.52–1.92) and stroke (HR, 1.94, 95 percent CI, 1.56–2.41), both of which were nearly twice as likely to occur in BD patients than in non-BD comparators. In contrast, reinfarction was 17-percent less likely to occur in the BD group (HR, 0.83, 95 percent CI, 0.69–1.00).

Of note, heart failure (9.1 percent vs 6.5 percent) and valve disease (5.3 percent vs 3.5 percent) were also present at a higher frequency in the BD group at baseline. The same was true for anaemia (8.7 percent vs 5.8 percent), stroke (11.8 percent vs 7.8 percent), and chronic obstructive pulmonary disease (13.4 percent vs 9.3 percent; p<0.05 for all).