Abstract
This narrative review, with an emphasis on children and adolescents, addresses the
link between 5 psychiatric disorders and cardiovascular risk: attention deficit hyperactivity
disorder, autism spectrum disorders, anxiety disorders, depression, and bipolar disorders.
The evidence regarding cardiovascular risk factors, noninvasive measures of early
atherosclerosis, and cardiovascular disease prevalence and/or mortality is summarized.
Whereas multiple studies have examined stimulant treatment of attention deficit hyperactivity
disorder in relation to cardiovascular death, and autonomic-vagal function in autism
spectrum disorders, little is known regarding atherosclerotic cardiovascular disease
in patients with these conditions. For anxiety disorders, there is a gap in knowledge
regarding cardiovascular risk in clinical samples of youth. In contrast to the adult
literature, there are few studies regarding depression diagnoses, as opposed to self-reported
symptoms, in relation to cardiovascular risk in youth. For bipolar disorder, youth
studies focused on epidemiologic samples and various mood-stabilizing medications
are warranted. General recommendations for future research include: larger samples,
prospective repeated measures studies, and the integration of clinical and biological
mediators with noninvasive measures of early atherosclerosis. Overall, the potential
implications of cardiovascular risk factors are multiplied in youth with psychiatric
conditions, because these risk factors are relevant not only to cardiovascular disease
but to mental health and cognitive function. A shift in thinking regarding treatment
paradigms for youth with psychiatric disorders is warranted. Pending changes in clinical
practice guidelines and care delivery models, patients, families, clinicians, and
policy makers can act on currently available information to reduce cardiovascular
risk among children and adolescents with psychiatric disorders.
Résumé
Dans le cadre d’une revue non systématique centrée sur les enfants et les adolescents,
nous avons étudié le lien entre le risque cardiovasculaire et cinq troubles psychiatriques
: le trouble d'hyperactivité avec déficit de l'attention (THDA) les troubles du spectre
de l’autisme, les troubles de l’anxiété, la dépression et les troubles bipolaires.
Nous présentons une synthèse des données probantes relatives aux facteurs de risque
cardiovasculaire, aux évaluations non invasives de l’athérosclérose précoce et à la
prévalence de la maladie cardiovasculaire et/ou de la mortalité d’origine cardiovasculaire.
Même si de multiples études ont examiné le lien entre le traitement du THDA au moyen
d’un agent stimulant et le décès d’origine cardiovasculaire ou encore le rôle de la
fonction du système nerveux parasympathique dans les troubles du spectre de l’autisme,
on en sait peu sur la maladie cardiovasculaire athéroscléreuse chez les patients atteints
de tels troubles psychiatriques. Dans le cas des troubles de l’anxiété, on dispose
de peu de données sur le risque cardiovasculaire chez les jeunes formant les échantillons
cliniques. Contrairement aux études menées chez les adultes, peu d’études réalisées
auprès de jeunes examinent le lien entre le diagnostic de dépression, par opposition
aux symptômes autodéclarés, et le risque cardiovasculaire. En ce qui concerne les
troubles bipolaires, des études portant sur des échantillons épidémiologiques de jeunes
patients et sur divers stabilisateurs de l’humeur s’imposent. Parmi les recommandations
générales concernant la réalisation de futures études, citons : le recours à de plus
vastes échantillons, la réalisation d’études prospectives à mesures répétées et l’intégration
de mesures non invasives des médiateurs cliniques et biologiques de l’athérosclérose
précoce. Dans l’ensemble, les répercussions possibles des facteurs de risque cardiovasculaire
sont multipliées chez les jeunes atteints d’un trouble psychiatrique, parce que ces
facteurs de risque intéressent non seulement la maladie cardiovasculaire, mais aussi
la santé mentale et la fonction cognitive. Un changement de paradigme pour le traitement
des jeunes atteints d’un trouble psychiatrique s’impose. D’ici à ce que les lignes
directrices de pratique clinique et les modèles de prestation des soins soient mis
à jour, les patients, leurs familles, les cliniciens et les décideurs peuvent intervenir
en se fiant aux données existantes afin de réduire le risque cardiovasculaire chez
les enfants et les adolescents atteints d’un trouble psychiatrique.
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Article info
Publication history
Published online: July 03, 2020
Accepted:
June 29,
2020
Received:
February 9,
2020
Footnotes
See page 1401 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
