Bipolar Disorder and the Risk of Cardiovascular Diseases: A Systematic Review and Meta‐Analysis of Observational Studies

INTRODUCTION: Bipolar disorder (BD) is a chronic psychiatric illness characterized by recurrent manic and depressive episodes, affecting 2% of the global population. It is associated with premature mortality, including cardiovascular disease (CVD)-related mortality. Although clinically important, the absolute burden and incidence of cardiovascular outcomes in BD remain incompletely characterized. This systematic review and meta-analysis synthesized observational evidence on CVD prevalence and incidence in adults with BD. METHODS: Following PRISMA guidelines and prospectively registered in PROSPERO (CRD42023484712), we searched PubMed, Web of Science, Embase, Scopus, and PsycInfo, screening 11,909 records. Thirty-two observational studies in adults with BD were included after Newcastle-Ottawa Scale assessment. Data were extracted on overall CVD, coronary artery disease, cerebrovascular disease, peripheral arterial disease, comorbidities, and psychotropic exposure. Pooled prevalence and incidence rate ratios were calculated using random-effects models when data were comparable. RESULTS: The pooled CVD prevalence in BD was 7.70% (95% CI: 5.07-11.52), with coronary artery disease at 6.89% (95% CI: 4.05-11.47), cerebrovascular disease at 4.45% (95% CI: 2.13-9.05), and peripheral arterial disease at 3.30% (95% CI: 1.66-6.45). However, prevalence estimates showed extreme heterogeneity and should be interpreted as broad indicators of absolute burden rather than precise estimates for a single BD population. In controlled incidence studies, BD was associated with increased CVD incidence (IRR 1.66, 95% CI: 1.32-2.08), with elevated coronary and cerebrovascular estimates. Clinical variable analyses involving medication use, lifestyle factors, and cardiometabolic comorbidities were not feasible because reporting was insufficient and noncomparable. CONCLUSION: Adults with BD show substantial cardiovascular burden and increased incidence. However, extreme heterogeneity, limited incidence data, observational designs, and insufficient moderator reporting limit the precision and generalizability of pooled estimates. These findings support integrated cardiovascular screening in BD populations and future prospective studies. TRAIL REGISTRATION: PROSPERO CRD42023484712.