Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women

Abstract

IMPORTANCE Bulimia nervosa is associated with short-term cardiovascular complications in women, but its long-term consequences on cardiovascular health are unknown.OBJECTIVE To study the association of bulimia nervosa with the long-term risk of cardiovascular disease and mortality in women. DESIGN, SETTING, AND PARTICIPANTSIn this longitudinal cohort study, 416 709 women hospitalized in Quebec, Canada, including women hospitalized for bulimia nervosa and those for pregnancy-related events as a comparison group, were followed up for 12 years from 2006 to 2018 to identify incidences of cardiovascular disease and death.EXPOSURES At least 1 hospitalization for bulimia nervosa. MAIN OUTCOMES AND MEASURESThe study participants were followed up to identify future incidences of cardiovascular disease and deaths. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs to assess the association of bulimia nervosa with future outcomes after adjustment for patient characteristics. RESULTSThe study population comprised 818 women who were hospitalized for bulimia nervosa (mean [SD] age, 28.3 [13.4] years) and 415 891 hospitalized for pregnancy-related events (mean [SD] age, 28.3 [5.4] years). Patients were followed up for a total of 2 957 677 person-years. The women hospitalized for bulimia nervosa had a greater incidence of cardiovascular disease compared with those hospitalized for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs 1.02 [95% CI, 0.99-1.06] per 1000 person-years). Incidence of future cardiovascular disease was even higher for women with 3 or more bulimia admissions (25.13 [95% CI,] per 1000 person-years). Women hospitalized for bulimia nervosa had 4.25 (95% CI, 2.98-6.07) times the risk of any cardiovascular disease and 4.72 (95% CI, 2.05-10.84) times the risk of death compared with women hospitalized for pregnancy-related events. Bulimia nervosa was found to be associated with ischemic heart disease (HR, 6.63; 95% CI, 3.34-13.13), atherosclerosis (HR, 6.94; 95% CI, 3.08-15.66), and cardiac conduction defects (HR, 2.99; 95% CI,. Bulimia was also associated with 21.93 (95% CI,) times the risk of myocardial infarction at 2 years of follow-up and 14.13 (95% CI, 6.02-33.18) times the risk at 5 years of follow-up.CONCLUSIONS AND RELEVANCE This study's findings suggest that bulimia nervosa may be associated with the long-term risk of any cardiovascular disease, such as ischemic cardiac events and conduction disorders, as well as with death among women. The findings also suggest that women with a history of bulimia nervosa should be screened regularly for ischemic cardiovascular disease and may benefit from prevention of and treatment for cardiovascular risk factors.

Short‐term very low caloric intake causes endothelial dysfunction and increased susceptibility to cardiac arrhythmias and pathology in male rats

“…This short period of time is not uncommon among dieters on very low caloric diets. These findings support a recent study by Tith et al (2019) that followed women with bulimia nervosa for up to 12 years and found a striking increase in the risk of cardiovascular disease, including ischaemic heart disease, atherosclerosis and cardiac conduction defects. Thus, our studies in rats warrant investigation of cardiovascular function in individuals subjected to short periods of sFR either because of crash dieting or other causes (e.g.…”

“…Caloric intake can also be inadequate for other voluntary reasons (e.g. bulimia nervosa; Tith et al, 2019) or involuntary reasons (e.g. poverty, natural disasters, war).…”

From gut microbiota to host appetite: gut microbiota-derived metabolites as key regulators

“…Individuals with AN show severe underweight, and other psychiatric complications include depression and anxiety [7,193]. An increasing number of studies indicate that individuals with BN and binge eating disorders have higher incidence rates of obesity and related metabolic diseases, such as type 2 diabetes and cardiovascular disease compared to individuals with no history of eating disorders [194][195][196].…”

Anorexia nervosa and the long‐term risk of mortality in women

“…Among a longitudinal cohort of 1,298,890 women from the Maintenance and Use of Data for the Study of Hospital Clientele registry 4 in the province of Quebec, Canada, we identified women admitted to hospital for anorexia nervosa between 1989 and 2016. A comparison group of women of similar age who presented for either delivery or pregnancy termination and were representative of the large majority of women in Quebec was also identified.…”