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Major depressive disorder and bipolar disorder, which together affect approximately 10% of U.S. adolescents, pose moderate risk for accelerated atherosclerosis and early cardiovascular disease (CVD), according to a new scientific statement from the American Heart Association.
The statement, available free of charge in Circulation, offers an algorithm for managing this excess risk. The first steps: Once an adolescent is diagnosed with major depression or bipolar disorder, he or she should be assessed for other cardiovascular risk factors, including family history of early CVD, smoking history, and elevated blood pressure. Patients with at least two additional risk factors should be considered high risk and given tighter treatment targets (e.g., BMI ≤85th percentile and blood pressure ≤90th percentile); otherwise, they should remain in the moderate-risk group, with slightly less stringent goals (e.g., BMI ≤90th percentile and BP ≤95th percentile).
The statement examines evidence supporting the link between mood disorders and CVD and suggests possible behavioral and biological mechanisms. It also considers the metabolic effects of mood-stabilizing drugs.
Peter Roy-Byrne, editor-in-chief of NEJM Journal Watch Psychiatry, observes: “This is a valuable addition to the literature because much previous work has focused on the association between mood disorders and CVD in middle-age and older adults in whom there may be less benefit of preventive treatment. Focusing on teens will allow more time for preventive strategies to have a beneficial effect in reducing CV risk over time.”
Goldstein BI et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: A Scientific Statement from the American Heart Association. Circulation 2015 Aug 10; [e-pub]. (http://dx.doi.org/10.1161/CIR.0000000000000229)
Comment — Pediatrics and Adolescent Medicine
The observation that mood disorders in adolescents are associated with accelerated atherosclerosis and early cardiovascular disease is important for pediatric practice. The recommendation for screening risk factors in all adolescents with depression or bipolar disorder and targeting a healthy weight in high risk patients is reasonable. However, to carry out such a program, we will need to improve access to individual or group cognitive behavioral therapy to achieve levels of healthy weight in our teenage patients. Simply encouraging more physical activity and better nutrition produces effective results in a minority of patients.