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Canadian Journal of Cardiology

Links Between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk

      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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