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Original Research

Randomized Controlled Trial to Assess Reduction of Cardiovascular Disease Risk in Patients With Bipolar Disorder: The Self-Management Addressing Heart Risk Trial (SMAHRT)

Amy M. Kilbourne, PhD, MPH; David E. Goodrich, EdD; Zongshan Lai, MPH; Edward P. Post, MD, PhD; Karen Schumacher, RN; Kristina M. Nord, MSW; Margretta Bramlet, MEd; Stephen Chermack, PhD; David Bialy, MS, PA-C; and Mark S. Bauer, MD

Published: July 15, 2013

Article Abstract

Objectives: Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. We hypothesized that the Life Goals Collaborative Care (LGCC) intervention, compared to enhanced usual care, would reduce CVD risk factors and improve physical and mental health outcomes in US Department of Veterans Affairs patients with bipolar disorder.

Method: Patients with an ICD-9 diagnosis of bipolar disorder and ≥ 1 CVD risk factor (N = 118) enrolled in the Self-Management Addressing Heart Risk Trial, conducted April 2008-May 2010, were randomized to LGCC (n = 58) or enhanced usual care (n = 60). Life Goals Collaborative Care included 4 weekly self-management sessions followed by tailored contacts combining health behavior change strategies, medical care management, registry tracking, and provider guideline support. Enhanced usual care included quarterly wellness newsletters sent during a 12-month period in addition to standard treatment. Primary outcome measures included systolic and diastolic blood pressure, nonfasting total cholesterol, and physical health-related quality of life.

Results: Of the 180 eligible patients identified for study participation, 134 were enrolled (74%) and 118 completed outcomes assessments (mean age = 53 years, 17% female, 5% African American). Mixed effects analyses comparing changes in 24-month outcomes among patients in LGCC (n = 57) versus enhanced usual care (n = 59) groups revealed that patients receiving LGCC had reduced systolic (β = −3.1, P = .04) and diastolic blood pressure (β = −2.1, P = .04) as well as reduced manic symptoms (β = −23.9, P = .01). Life Goals Collaborative Care had no significant impact on other primary outcomes (total cholesterol and physical health-related quality of life).

Conclusions: Life Goals Collaborative Care, compared to enhanced usual care, may lead to reduced CVD risk factors, notably through decreased blood pressure, as well as reduced manic symptoms, in patients with bipolar disorder.

Trial Registration: identifier: NCT00499096

J Clin Psychiatry 2013;74(7):e655-e662

Submitted: August 6, 2012; accepted November 7, 2012 (doi:10.4088/JCP.12m08082).

Corresponding author: Amy M. Kilbourne, PhD, MPH, VA Ann Arbor Center for Clinical Management Research and National Serious Mental Illness, Treatment Resource & Evaluation Center, North Campus Research Complex, 2800 Plymouth Rd, Bldg 14, Ann Arbor, MI 48109-2800 (

Volume: 74

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