Cardiometabolic disorder comorbidity within affective disorders: analysis of 1.6 million participants in the Our Future Health cohort

BackgroundAffective disorders - including bipolar disorder, depression and anxiety disorders - are associated with increased risk of cardiometabolic disorders and premature mortality. AimTo assess prevalence and the association of cardiometabolic comorbidity in people with bipolar disorder, major depression and anxiety disorders within the Our Future Health population cohort. MethodWe analysed associations between affective and cardiometabolic disorders in 1,584,273 UK-based adults. Participants were split into three affective disorder groups based on self-reported lifetime diagnoses: bipolar disorder (n = 8,555); depressive disorders (n = 275,746); and anxiety disorders (n = 49,645); plus a comparison group of participants with no self-reported history of mental health problems (n = 1,250,327). For each group, we calculated age-sex standardised prevalence and sex-stratified standardised prevalence of self-reported lifetime diagnoses of any cardiometabolic disorder, nine individual cardiometabolic disorders and cardiometabolic multimorbidity. We calculated odds ratios for cardiometabolic disorders for each group, adjusted for age, sex, ethnicity, household income, smoking status, alcohol consumption, activity levels, chronotype and educational attainment. ResultsThe standardised prevalence [95% confidence interval] of any cardiometabolic disorder within each of the affective disorders groups was higher than in the comparison group. For bipolar disorder this was 41.14% [39.36, 42.93], for depressive disorders 36.75% [36.49, 37.02] and for anxiety disorders 28.79% [28.38, 29.38], compared to 24.75% [24.66, 24.83] in the comparison group. There were sex-specific differences, with the prevalence of all cardiometabolic disorders except obesity elevated more in males than in females across each affective disorder group. Adjusted odds ratios of each of the nine individual cardiometabolic disorders were increased for bipolar disorder and for depressive disorders, and the adjusted odds of all except myocardial infarction were increased for anxiety disorders, albeit at a lower magnitude. For example, for type II diabetes, the adjusted odds ratios [95% confidence intervals] were 2.75 [2.46, 3.08] in bipolar disorder, 1.99 [1.93, 2.05] in depressive disorders and 1.11 [1.02, 1.21] in anxiety disorders, and for hypertension this was 1.62 [1.50, 1.76] in bipolar disorder, 1.62 [1.59, 1.65] in depressive disorders and 1.31 [1.27, 1.36] in anxiety disorders. ConclusionsWe identified high rates of cardiometabolic comorbidity for bipolar disorder, depression and anxiety disorders within a cohort of 1.6 million participants. These associations were independent of a range of potential confounding factors. Future work should seek to understand why risk of cardiometabolic disorder is particularly high in people with bipolar disorder and in men.