Written by Angeline A. De Leon, Staff Writer. Study suggests that bulimia nervosa may be associated with the long-term risk of any cardiovascular disease, as well as with death among women.
Bulimia nervosa, a serious eating disorder marked by a cycle of binge eating followed by compensatory purging, is one of the most common eating disorders among women 1. Due to excessive fluid loss during purging, bulimia has been linked to electrolyte imbalance and acute risk of heart arrhythmia, even sudden cardiac death 2. Other short-term changes associated with bulimia include lower blood pressure and blood oxygen levels 1 and hypokalemia (low potassium levels) 3. Bulimia may also lead to detrimental metabolic changes, such as significantly increased cholesterol and triglyceride levels4, and endocrine alterations, such as reduced estrogen levels, which are negatively related to cardiovascular health 5. Furthermore, this eating disorder is concomitant with high levels of stress and anxiety, well-known risk factors for cardiovascular events in general 6,7. Despite evidence from the literature linking bulimia nervosa to acute risk for cardiovascular disease (CVD), the longer-term association between bulimia and development of CVD is not well known. Thus, in 2019, a study 8 published in JAMA Psychiatry investigated the link between bulimia nervosa and cardiovascular mortality in a longitudinal cohort of women.
A longitudinal cohort study was carried out in a group of 818 women (with a history of at least one previous hospitalization for bulimia) who were hospitalized for bulimia nervosa (mean age = 28.3 years), along with a comparison group of 415,891 women who were hospitalized for a pregnancy-related event (mean age = 28.3 years). Patients were followed for 12 years, from the time of admission to the time of the first incidence of a CVD event. Diagnostic codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) were used to identify CVD events, and hazard ratios (HRs) were calculated to estimate the association of bulimia with future CVD.
Data analysis confirmed that compared to pregnancy-related hospitalization, hospitalization for bulimia was associated with significantly higher incidence of CVD (10.34 [95% Confidence Interval: 7.77 to 13.76] vs. 1.02 [95% CI: 0.99 to 1.06] per 1000 person-years) and death (3.21 [95% CI: 1.97 to 5.25] vs. 0.10 [95% CI: 0.09 to 0.11] per 1000 person-years). Incidence of future CVD was highest for women with three or more hospital admissions for bulimia (25.13 [95% CI: 2.00 to 2.49]). Overall, hospitalization for bulimia vs. any pregnancy-related event was linked to a 4.25 times greater risk of any CVD (95% CI: 2.98 to 6.07) and 4.72 times greater risk of death during follow-up (95% CI: 2.05 to 10.84). In adjusted models, bulimia was associated with myocardial infarction (HR = 5.48, 95% CI: 1.80 to 16.70), ischemic heart disease (HR = 6.63, 95% CI: 3.34 to 13.13), conduction disorders (HR = 2.99, 95% CI: 1.57 to 5.71), and atherosclerosis (HR = 6.94, 95% CI: 3.08 to 15.66).
Based on the present study, evidence suggests a probable relationship between bulimia nervosa and the long-term risk for CVD. In a large cohort of women, an association between hospitalization for bulimia and elevated risk for CVD and mortality was found to emerge over the course of 12 years. In fact, diagnosis of bulimia nervosa resulted in a more than 4-fold increase in risk of CVD development and death. This pattern was consistent for a range of different CVD events, including myocardial infarction, ischemic heart disease, and atherosclerosis. Thus, findings from the current study suggest that the eating disorder, bulimia nervosa, leads to detrimental effects on the cardiovascular system in the long-term as well as short-term. Notable limitations of the study relate to the exclusion of milder cases of bulimia which might not warrant hospitalization, as well as the absence of information on the duration of bulimia for individual patients. It would be valuable in the future to ascertain the relationship between relapse episodes and CVD events. Finally, deeper insight into the link between bulimia and long-term CVD complications would be possible with even longer follow-up periods in future trials.
Source: Tith RM, Paradis G, Potter BJ, et al. Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry. 2019. DOI: 10.1001/jamapsychiatry.2019.2914.
© 2019 American Medical Association. All rights reserved.
Posted January 6, 2020.
References:
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- Mehler PS, Rylander M. Bulimia Nervosa–medical complications. Journal of eating disorders. 2015;3(1):12.
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- Warren MP. Endocrine manifestations of eating disorders. The Journal of Clinical Endocrinology & Metabolism. 2011;96(2):333-343.
- Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. American journal of hypertension. 2015;28(11):1295-1302.
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- Tith RM, Paradis G, Potter BJ, et al. Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women. JAMA psychiatry. 2019.
