Cumulative Cardiovascular Disease Risk and Triglycerides Differentially Relate to Subdomains of Executive Function in Bipolar Disorder; preliminary findings

J Affect Disord. 2021 Jan 1:278:556-562. doi: 10.1016/j.jad.2020.09.104. Epub 2020 Sep 29.


Objectives: Cardiovascular disease is disproportionally prevalent in bipolar disorder (BD) and has been linked to cognition in preliminary studies. Herein we evaluate the association between known risk factors for cardiovascular disease and executive function in BD patients compared to healthy controls.

Methods: In a sample of n=57 individuals (n=23 BD, n=34 controls) we assessed two subdomains of executive function; cognitive flexibility (using the Trail Making Test - Part B) and cognitive inhibition (using the Stroop Colour Word Interference Task). Cardiovascular risk was assessed by means of serum triglyceride levels, body mass index (BMI) and waist circumference, as well as dietary saturated fat intake and a sex-specific cumulative cardiovascular risk score calculated using the Framingham Heart Study method.

Results: Patients with BD had higher BMI and waist circumference, with more BD patients categorized as having central obesity than controls. In the BD group only, higher triglyceride levels were associated with worse cognitive flexibility, and elevated cumulative cardiovascular disease risk was associated with worse cognitive inhibition. No correlations between cardiovascular risk factors and executive function were evident in the control group.

Limitations: The study was limited by the small sample size and should be considered hypothesis-generating CONCLUSIONS: The associations between triglyceride levels, cumulative cardiovascular disease risk and executive functioning evident in BD in this study preliminarily indicate the potential for mechanistic overlap of physical health and cognitive function in the disorder.

Keywords: BMI; Cognition; Cognitive flexibility; Cognitive inhibition; Depression; Diet; Framingham heart risk score; Heart; Lipids; Mental health; Metabolic syndrome; Neuropsychology; Obesity; Psychiatry.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bipolar Disorder* / epidemiology
  • Cardiovascular Diseases* / epidemiology
  • Cognition
  • Executive Function
  • Female
  • Humans
  • Male
  • Neuropsychological Tests
  • Triglycerides


  • Triglycerides