Abstract Body: Introduction: Prior research has suggested that psychiatric disease, particularly bipolar disorder, may increase the risk of cardiovascular events and stroke.

Methods: We performed a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). The primary outcome was major adverse cardiovascular events (MACE) and the secondary outcome was stroke. The study exposure was self-reported bipolar disorder at study baseline. We fit time to event models and adjusted for potential confounders.

Results: We included 9,148 SPRINT participants (Table 1), of which 175 (1.9%) had self-reported bipolar disorder at study baseline. During a mean of 3.7 years of follow-up, MACE events were observed in 7.7% of those without bipolar versus 12% if those with bipolar (p=0.036) (Figure 1). There were only 3 stroke events in the bipolar group, making estimations unreliable so it was discarded as an outcome. In a multivariable Cox model adjusted for demographic variables and medical comorbidities seen in Table 1, the adjusted hazard ratio of MACE associated with bipolar disorder was 2.04 (95% CI 1.31-3.17, p=0.001). When also including other psychiatric comorbidities in the model, we found that none were associated with MACE and that adjusting for them did not impact the findings (HR 1.98, 95% CI 1.24-3.16, p=0.004).

Conclusion:
SPRINT trial patients with bipolar disorder experienced a significantly greater rate of major adverse cardiovascular events compared to those without bipolar disorder. Other psychiatric comorbidities were not associated with an increased risk of MACE. However, due to limited data, it remains uncertain if stroke rates are also elevated in patients with bipolar disorder, highlighting the need for further studies to investigate this potential risk.