Increased age and cardiometabolic risk factors are associated with poorer diastolic function in individuals with bipolar disorder, while lithium use was associated with better diastolic function and a lower left ventricular mass index.
Key Findings
Results
Patients with bipolar disorder had significantly lower diastolic function measures compared to mentally healthy controls across multiple echocardiographic parameters.
The BD group had significantly lower E velocity (Cohen d = 0.40) compared to controls
Septal e' velocity was lower in BD patients (Cohen d = 0.65), representing the largest effect size among the diastolic parameters
Average e' velocity was lower in BD patients (Cohen d = 0.41)
E/A ratio was lower in BD patients (Cohen d = 0.42)
Left atrial conduit strain was higher (indicating greater impairment) in BD patients (Cohen d = 0.38)
Results
Age was significantly associated with poorer diastolic function in patients with bipolar disorder.
Multiple linear regression analysis identified age as a significant predictor of diastolic function in the BD group
The study recruited individuals under age 45, meaning these diastolic changes were occurring in a relatively young population
The association was identified independently of other cardiometabolic risk factors in the regression model
Results
Multiple cardiometabolic risk factors were significantly associated with poorer diastolic function in patients with bipolar disorder.
Diastolic blood pressure was significantly associated with poorer diastolic function in the BD group
Serum fasting insulin was significantly associated with poorer diastolic function
Homeostasis model assessment of insulin resistance (HOMA-IR) was significantly associated with poorer diastolic function
Body mass index (BMI) was significantly associated with poorer diastolic function
All associations were identified via multiple linear regression analysis
Results
Lithium use was associated with better diastolic function and a lower left ventricular mass index in patients with bipolar disorder.
Lithium use was identified as a significant variable in multiple linear regression analysis in the BD group
Lithium was associated with better diastolic function, in contrast to the cardiometabolic risk factors which were associated with worse function
Lithium use was also associated with a lower left ventricular mass index
This finding suggests a potentially cardioprotective role of lithium in BD patients
Methods
The study recruited a sample of 127 individuals under age 45 without clinical heart failure, using both conventional and speckle-tracking echocardiography.
Total sample consisted of 127 individuals: 65 with bipolar disorder and 62 mentally healthy controls
All participants were under age 45 and without a clinical diagnosis of heart failure
Echocardiographic procedures were performed in accordance with the recommendations of the American Society of Echocardiography
Both conventional echocardiography and speckle-tracking echocardiography were used
Cardiometabolic risk factors were obtained using standard in-hospital examinations
Background
Asymptomatic diastolic dysfunction in bipolar disorder patients is an underexamined area, with few prior studies evaluating cardiac diastolic function or its risk factors in this population.
The authors note that few studies have evaluated cardiac diastolic function in patients with bipolar disorder
Few studies have examined risk factors associated with asymptomatic diastolic dysfunction in BD
Asymptomatic diastolic dysfunction is noted to be associated with heart failure and reduced survival in the broader literature
What This Means
This research suggests that people with bipolar disorder (BD) show measurable signs of reduced heart function — specifically in how well the heart relaxes and fills with blood between beats (diastolic function) — even when they are young (under 45) and have no diagnosed heart disease. When comparing 65 people with BD to 62 mentally healthy individuals of similar age, those with BD showed worse performance on multiple measures of cardiac diastolic function, with the differences being moderate in size. These findings indicate that heart changes in BD may begin silently and at a relatively early age.
The study also found that certain risk factors — including higher diastolic blood pressure, higher insulin levels, insulin resistance, and higher body mass index — were linked to worse heart function specifically in the BD group. Getting older was also associated with greater diastolic impairment. Notably, patients who were taking lithium, a common mood-stabilizing medication, showed better diastolic function and a healthier heart muscle size compared to those not on lithium, suggesting lithium may have a protective effect on the heart.
This research suggests that heart health monitoring should be a routine part of care for people with bipolar disorder, even those who are relatively young and show no heart symptoms. The findings highlight the potential importance of managing metabolic risk factors — such as blood pressure, weight, and insulin resistance — as part of comprehensive mental health treatment for people with BD. The possible cardioprotective effect of lithium is also a noteworthy finding that may have implications for treatment decisions, though further research would be needed to confirm this relationship.
Hsiao C, Lin Y, Lai H, Hsieh K, Chung K, Chiang S, et al.. (2026). Association of age and cardiometabolic risk factors with cardiac diastolic function change in patients with bipolar disorder.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2026.122024