Coronary calcium score as an expression of multisystemic progression of bipolar disorder

摘要

We read with interest the study by Wageck et al. recently published in Revista Brasileira de Psiquiatria. In their analysis, the authors describe a positive association between number of hospitalizations and coronary calcium score (CCS), a well-defined predictor of cardiovascular mortality in the general population, in individuals with bipolar disorder (BD). In the Discussion, the authors hypothesize that the activation of inflammatory response which is associated with mood episodes, especially more severe episodes (i.e., those requiring hospitalization), may be a causal explanation for the premature onset or progression of atherosclerotic pathology, although inflammatory status was not assessed in the study. While the results of this study still need to be replicated, they provide novel insights into the systemic pathophysiology associated with severe and recurrent mood disorders. In addition to being neuroprogressive illnesses, mood disorders are perhaps more comprehensively conceptualized as conditions of multisystemic progression. In accordance with this view, multisystemic progression would be mediated by persistent inflammatory activation, insulin resistance, and oxidative stress. , Within this framework, cardiovascular disease seems to be a final common endpoint of the alterations and effector systems mentioned earlier.