The American Heart Association (AHA) has issued a scientific statement communicating and reviewing evidence showing that major depressive disorder (MDD) and bipolar disorder (BD) in youth increase the risk of accelerated atherosclerosis and early cardiovascular disease (CVD). The statement reviews the evidence and concludes:

• MMD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD, increasing the risk of early heart disease by 2-3 fold.

• The prevalence of MMD and BD is 10-fold higher than the prevalence of other tier 2 risk factors combined. Those other tier 2 risk factors are Kawasaki disease with regressed coronary aneurysms, chronic inflammatory disease (systemic lupus erythematosus, juvenile inflammatory arthritis), HIV infection, and nephrotic syndrome.

• MDD and BD should be considered tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations.

• Integrating factors that underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.

Citation: Goldstein BI, Carnethon MR, Matthews KA, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease. Circulation. [Published online ahead of print August 10, 2015]. doi: 10.1161/CIR.0000000000000229.

Commentary: The prevalence of MDD and BD among adolescents in the US is approximately 11% with MDD having a prevalence of about 9% and BD about 2%¹. The evidence linking MMD and BD is based on epidemiology, measurement of carotid intimal thickness, and endothelial dysfunction making the conclusion strong and convincing. It is unclear whether some of the relation is a product of lifestyle differences such as increased smoking, less exercise, and poorer diets that people with MMD and BD may have compared to the general population. The important clinical take-home point is that in adolescents and young adults with MDD and BD, we need to pay heightened attention to addressable risk factors such as smoking, high blood pressure, high cholesterol, diet and exercise. —Neil Skolnik, MD

1. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–989. doi: 10.1016/j.jaac.2010.05.017.