Youth isn’t automatic protection from heart disease — especially if teens are depressed or bipolar.
Heart disease is the leading cause of death for both men and women in the U.S., according to the Centers for Disease Control and Prevention. And while middle-aged and older folks, especially those who are overweight and sedentary, often are at risk for cardiovascular disease, a new report from the American Heart Association (AHA) found another group is also surprisingly at risk — adolescents suffering from major depression or bipolar disorder.
In fact, after analyzing published studies of cardiovascular events such as heart attacks and deaths among young people, an AHA committee of medical experts found that teens with major depression or bipolar disorder are more likely than other youngsters to have a host of cardiovascular disease risk factors, including hardening of the arteries.
Previous studies have shown people with heart disease are more likely to suffer from depression than otherwise healthy people. Researchers have also found that symptoms of depression can reduce overall health, potentially increasing the risk for cardiovascular disease or making existing heart disease symptoms worse, according to the National Institute of Mental Health. Even a broken heart can be deadly.
But the AHA report concluded the association between cardiovascular disease risk in young people and certain mental health problems isn’t widely known — but it should be recognized as a moderate risk factor for cardiovascular disease in teens. In fact, the authors of the AHA report recommend early monitoring for heart and blood vessel disease among adolescents with major depression and bipolar disorder.
"Youth with mood disorders are not yet widely recognized as a group at increased risk for excessive and early heart disease. We hope these guidelines will spur action from patients, families, and healthcare providers to reduce the risk of cardiovascular disease among these youth," said Benjamin I. Goldstein, MD, PhD, lead author of the AHA report and a child-adolescent psychiatrist at Sunnybrook Health Sciences Center and the University of Toronto.
Major depression, characterized by chronic feelings of sadness and loss of interest in activities once enjoyed, and bipolar disorder, marked by mood swings between depression and mania, are common mood disorders. They affect about 10 percent of American teens, according to the AHA report.
Exactly why these mood disorders are associated with cardiovascular disease remains unknown. However, the AHA panel noted inflammation and other types of cell damage, which some studies have found are more common in teens with mood disorders compared to other adolescents, may play a role.
The AHA report also pointed out that young people with mood disorders are more likely than other teens to be drug abusers and to engage in other unhealthy behaviors such as smoking and being physically inactive. However, those factors aren’t enough to explain why depressed and bipolar youngsters are more likely to develop cardiovascular ills, according to the AHA analysis.
(The AHA offers additional information on cardiovascular disease and how to lower your risk for heart attack and stroke.)
What’s more, the use of prescription drugs to treat mood disorders in teens doesn’t fully explain the increased cardiovascular risk, either. While it’s true some mood medications increase blood pressure and can cause weight gain, higher levels of cholesterol, and blood-sugar levels, the majority of teens in the studies analyzed for the AHA report were not taking medications.
"Mood disorders are often lifelong conditions, and managing cardiovascular risk early and assertively is tremendously important if we are to be successful in ensuring that the next generation of youth has better cardiovascular outcomes," Goldstein said. "These disorders indicate an increased risk of heart disease that requires increased vigilance and action at the earliest possible stage."
October 18, 2021
Christopher Nystuen, MD, MBA