Links between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk.Can J Cardiol. 2020 Jul 03 [Online ahead of print]CJ
This narrative review, emphasizing children and adolescents, addresses the link between five psychiatric disorders and cardiovascular risk: attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, anxiety disorders, depression, and bipolar disorders. The evidence regarding cardiovascular risk factors, non-invasive measures of early atherosclerosis, and cardiovascular disease prevalence and/or mortality is summarized. Whereas multiple studies have examined stimulant treatment of ADHD in relation to cardiovascular death, and autonomic-vagal function in autism spectrum disorders, little is known regarding atherosclerotic cardiovascular disease in 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 focusing 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 non-invasive measures of early atherosclerosis. Overall, the potential implications of cardiovascular risk factors are multiplied in youth with psychiatric conditions, as 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.