Evidence for accelerated vascular aging in bipolar disorder
Open accessAbstract
Objective Persons with bipolar disorder face excess risk of cardiovascular disease, although the biobehavioral mechanisms and time course are unclear. We measured vascular stiffness in a cross-sectional sample of participants with bipolar disorder and compared results to published normative data to assess time-course and relationship to behavioral risk factors.Methods 62 individuals with bipolar disorder (33±6.7years; 64% female) underwent non-invasive assessment of arterial stiffness through arterial applanation tonometry. Lifetime tobacco exposure was estimated on clinical interview. Physical activity was assessed using the long-version of the International Physical Activity Questionnaire (IPAQ). A food frequency questionnaire was used to compute Alternate Healthy Eating Index (AHEI), a measure of overall dietary quality. Medication histories were systematically abstracted from pharmacy records.Results Participants over the age of 32 (median split) had greater arterial stiffness than expected from age-based population norms for pulse wave velocity (PWV) (7.6 vs. 7.0m/s, p=.02) and estimated aortic augmentation pressure (AIx) (14.2 vs. 8.2%, p=.0002). The younger portion of the sample did not differ from population norms on these measures (PWV 6.3 vs. 6.4m/s, p=.45 and AIx 7.6 vs. 7.4%, p=.60). In the older half of the sample, physical activity was inversely associated with AIx and poorer diet marginally associated with PWV. These findings were independent of body mass index (BMI), which was strongly related to arterial stiffness.Conclusion Risk for vascular disease may be acquired over the long-term course of affective illness. This risk appears to reflect maladaptive health behaviors, which may be amenable to intervention.
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Bipolar disorder may also be characterized by 'accelerated aging'.
“Bipolar disorder (BD) may also be characterized by “accelerated aging” (Rizzo et al., 2014; Sodhi et al., 2012; Yatham et al., 2009 (but see Gildengers et al., 2013)).”
From Psychiatric disorders and leukocyte telomere length: Underlying mechanisms linking mental illness with cellular aging (2015) · cites this paper as Sodhi et al., 2012
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Mental Disorders as a Risk Factor of Acute Coronary Syndrome
Gupta, A., Tejpal, T., Seo, C., Fabiano, N., Zhao, S., Wong, S., Qiu, Y., MacNeil, J. L., Kim, D. R., Aleksova, N., et al. (2026) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2025.4253 · Cited by 13 · see citing works
Chen, P., Chang, C.-K., Chiang, S.-J., Lin, Y., Tsai, S., & Huang, S. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.004 · Cited by 13 · see citing works
Association of blood pressure with brain structure in youth with and without bipolar disorder
Kennedy, K. G., Grigorian, A., Mitchell, R. H. B., McCrindle, B. W., MacIntosh, B. J., & Goldstein, B. I. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.028 · Cited by 11 · see citing works
Meyer-Kalos, P., Lee, M. G., Studer, L. M., Line, T. A., & Fisher, C. M. (2016) · Community Mental Health Journal · doi:10.1007/s10597-016-0043-1 · Cited by 8 · see citing works
Moss, R. A., Finkelmeyer, A. E., Robinson, L. J., Thompson, J. M., Watson, S., Ferrier, I. N., & Gallagher, P. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00106 · Cited by 9 · see citing works
“The results of this study may fit within an accelerated cognitive aging interpretation of disease progression in BD (64, 65), as increased IIV is associated with age-related processes (17, 18).”
ResultTong, B., Abosi, O. J., Schmitz, S. L., Myers, J. E., Pierce, G. L., & Fiedorowicz, J. G. (2017) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2017.12.005 · Cited by 10 · see citing works
“Studies that failed to demonstrate an association between bipolar disorder and endothelial dysfunction have consisted of younger participants with mean age of 32 years and 33 years [39,40].”
Cerebellar Morphological Differences in Bipolar Disorder Type I
Harmata, G. I. S., Barsotti, E. J., Casten, L. G., Fiedorowicz, J. G., Williams, A. J., Shaffer, J. J., Richards, J. G., Sathyaputri, L., Schmitz, S. L., Christensen, G. E., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.08.018 · Cited by 9 · see citing works
Frequency and clinical correlates of bipolar features in acute coronary syndrome patients
Pini, S., Abelli, M., Gesi, C., Lari, L., Cardini, A., Paolo, L. D., Felice, F., Stefano, R. D., Mazzotta, G., Oligeri, C., et al. (2013) · European Psychiatry · doi:10.1016/j.eurpsy.2013.06.007 · Cited by 8 · see citing works
“007 ACS, and worsens outcome when present in patients with established ACS, suggesting that depression is associated with both physiological and psychosocial changes that are deleterious to the cardiovascular system [12,19,34,37].”
BackgroundNeurovascular correlates of retinal microvascular caliber in adolescent bipolar disorder
Mio, M., Grigorian, A., Zou, Y. Z., Dimick, M. K., Selkirk, B., Kertes, P. J., McCrindle, B. W., Swardfager, W., Hahn, M., Black, S. E., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.082 · Cited by 8 · see citing works
Atagün, M. İ., Sonugür, G., Yusifova, A., Celik, I., & Uğurlu, N. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.07.060 · Cited by 7 · see citing works
Inflammatory and Vascular Correlates of Mood Change Over 8 Weeks
Birdsall, J. W., Schmitz, S. L., Abosi, O. J., DuBose, L. E., Pierce, G. L., & Fiedorowicz, J. G. (2019) · Heart and Mind · doi:10.4103/hm.hm_24_19 · Cited by 7 · see citing works
“[4,5] In an effort to determine how this risk is mediated, prior studies of vascular function in mood disorders have shown a variety of vascular measurements to be impaired relative to controls, especially in older adults with a longer and more persistent course of illness.[6,7] In a year-long prospective study of 37…”
BackgroundLiou, Y., Chen, M., Hsu, J.-W., Huang, K., Huang, P., & Bai, Y. (2022) · Brain and Behavior · doi:10.1002/brb3.2570 · Cited by 7 · see citing works
“…activity and endothelial dysfunction-related arterial stiffness, such as FMD, pulse wave velocity, augmentation index (AIx), and reactive hyperemia index (RHI) (Fiedorowicz et al., 2012; Hatch et al., 2015; Murray et al., 2012; Rybakowski et al., 2006; Sodhi et al., 2012; Tong et al., 2018).”
BackgroundResultRapid Adipose Deposition with Mood Disorders
Fiedorowicz, J. G., Andersen, L. E., Persons, J. E., & Calarge, C. A. (2015) · Annals of Clinical Psychiatry · doi:10.1177/104012371502700407 · Cited by 6 · see citing works
“This adiposity may contribute to the previously reported association between manic symptom burden and endothelial dysfunction (12), arterial stiffness (10), and cardiovascular mortality (13).”
Outhred, T., McAulay, C., Gessler, D., & Malhi, G. S. (2016) · Springer eBooks · doi:10.1007/978-3-319-32480-7_19 · Cited by 6 · see citing works
Journal of psychosomatic research 2021 year in review
Fiedorowicz, J. G. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.110720 · Cited by 3 · see citing works
Mio, M., Chen, P., Kennedy, K. G., Blumberg, H. P., Bond, D. J., Goldwaser, E. L., Gomes, F. A., Greaney, J. L., Hájek, T., McElroy, S. L., et al. (2026) · Bipolar Disorders · doi:10.1111/bdi.70120 · Cited by 2 · see citing works
“Relative to comparison groups, this has been observed across a variety of measures including pulse wave velocity [123, 124], carotid elastic modulus [125], reactive hyperemia index [126], carotid intima media thickness [127], and augmentation index from pulse wave analysis [128, 129].”
Ewald, V. A. M., Purnell, J. R., Bruss, J. E., Barsotti, E. J., Aldine, A. S., Mahachi, K. G., Wemmie, J. A., Magnotta, V. A., Boes, A. D., Parker, K. L., et al. (2022) · The Cerebellum · doi:10.1007/s12311-022-01408-1 · Cited by 2 · see citing works
Self-citationZheng, X., Zhang, X., Zhang, Y., Chen, C., & Ji, E. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1392437 · Cited by 1 · see citing works
Arterial Stiffness in the Depression and Cardiovascular Comorbidity
Smith, E., & Singer, J. (2016) · Springer eBooks · doi:10.1007/978-3-319-32480-7_12 · Cited by 1 · see citing works
The Role of Sleep in Accelerated Cognitive Aging in Bipolar Disorder
Kaufmann, C. N., & Eyler, L. T. (2019) · Chronobiology in Medicine · doi:10.33069/cim.2019.0007 · Cited by 1 · see citing works
“tioning and levels of independence faster than otherwise healthy individuals [1,2].”
BackgroundFiedorowicz, J. G. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110499 · Cited by 1 · see citing works
Gober, L., Brown, A., Bunnell, A. P., Bunnell, B. E., & Ruddy, J. M. (2021) · Cardiology & Vascular Research · doi:10.33425/2639-8486.1122 · Cited by 1 · see citing works
“Volume 5 | Issue 5 | 5 of 6 Cardiol Vasc Res, 2021 that persons with bipolar disorder experience accelerated stiffening of the vasculature measured as increased pulse wave velocity and aortic augmentation pressure, independent of BMI [17].”
BackgroundThe search for mediators of vascular mortality with mania
Fiedorowicz, J. G., Linder, J. R., & Sodhi, S. K. (2014) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2013-3505 · Cited by 1 · see citing works
Exploración de un modelo de estadiaje clínico aplicado al trastorno bipolar
Tatay, A. (2015) · Dialnet (Universidad de la Rioja)
Huzayyin, A. A. S. (2013) · TSpace (University of Toronto)
Bipolar disorder and cardiovascular dysfunction: Mechanisms and implications
Mio, M., & Goldstein, B. I. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-819182-8.00019-3
Cerebellar Morphological Differences in Bipolar Disorder Type IPreprint
Harmata, G. I. S., Barsotti, E. J., Casten, L. G., Fiedorowicz, J. G., Williams, A. J., Shaffer, J. J., Richards, J. G., Sathyaputri, L., Schmitz, S. L., Christensen, G. E., et al. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.02.20.528549
“Participants with bipolar disorder were asked to retrospectively report estimated symptom burden over the course of the last decade (or since diagnosis, if less than 10 years prior), an approach used previously (Sodhi et al., 2012).”
MethodWang, T., Tsai, Y.-C., Huang, C.-C. J., Tsai, T.-Y., & Chang, Y.-H. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120834
Association between lithium and arterial atherosclerosis in physically healthy bipolar disorder
Tsai, S., Chang, T.-H., Sajatovic, M., Chen, P., Huang, Y., Hung, S., Chung, K., & Kuo, C. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122115
- Authors
- Sodhi, S. K., Linder, J., Chenard, C. A., Miller, D. D., Haynes, W. G., & Fiedorowicz, J. G.
- Affiliations
- University of Iowa (US)
- Corresponding author
- Fiedorowicz, Jess G.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 73
- Issue
- 3
- Pages
- 175-179
- ISSN
- 0022-3999 (ISSN-L)
- PMC
- PMC3410319
- OpenAlex
- W2025622628
- Cited by
- 57
- References
- 38
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 7 · 2015: 9 · 2014: 7 · 2013: 4
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1K23MH083695-01A210, P01 HL014388)
- Nellie Ball Research Trust
- Institute for Clinical and Translational Science at the University of Iowa (5UL1RR024979-05)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- bipolar disorder, vascular aging, arterial stiffness, pulse wave velocity, aortic augmentation index, cardiovascular risk, physical activity, diet quality, tobacco smoke exposure, body mass index, affective illness, applanation tonometry
- MeSH terms
- Adult, Age Factors, Bipolar Disorder, Cross-Sectional Studies, Diet, Female, Humans, Male, Middle Aged, Motor Activity, Risk Factors, Vascular Diseases, Health Behavior, Young Adult, Vascular Stiffness, Pulse Wave Analysis
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