Role of Neuroendocrine, Immune, and Autonomic Nervous System in Anorexia Nervosa-Linked Cardiovascular Diseases

Abstract

Anorexia nervosa represents a severe mental disorder associated with food avoidance and malnutrition. In patients suffering from anorexia nervosa, cardiovascular complications are the main reason leading to morbidity and mortality. However, the origin and pathological mechanisms leading to higher cardiovascular risk in anorexia nervosa are still unclear. In this aspect, the issue of exact pathological mechanisms as well as sensitive biomarkers for detection of anorexia nervosa-linked cardiovascular risk are discussed. Therefore, this review synthesised recent evidence of dysfunction in multiple neuroendocrine axes and alterations in the immune system that may represent anorexia nervosa-linked pathological mechanisms contributing to complex cardiovascular dysregulation. Further, this review is focused on identification of non-invasive biomarkers for the assessment of increased cardiovascular risk in anorexia nervosa that can be linked to a clinical application. Complex non-invasive assessment of cardiovascular autonomic regulation—cardiac vagal control (heart rate variability), sympathetic vascular activity (blood pressure variability), and cardiovascular reflex control (baroreflex sensitivity)—could represent a promising tool for early diagnosis, personalized therapy, and monitoring of therapeutic interventions in anorexia nervosa particularly at a vulnerable adolescent age.

Is the Activity-Based Anorexia Model a Reliable Method of Presenting Peripheral Clinical Features of Anorexia Nervosa?

“…Moreover, there is a lack of direct evidence of hypokalemia, heart remodeling, or myocardiocyte changes, which have been proposed to be responsible for conduction changes among human patients. Recently, it has also been suggested that research into cardiovascular complications of AN may, along with the assessment of HRV, additionally benefit from the assessment of microvascular damage [ 43 , 44 ].…”

A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa

“…PYY correlates inversely with BMI and fat mass. Levels of PYY are paradoxically elevated in patients with AN; this would not be adaptive to a state of chronic malnutrition but may play a role in the disorder's pathogenesis contributing to decreased nutrient intake and disordered eating psychopathology [47,48].…”

Peripheral Vascular Abnormalities in Anorexia Nervosa: A Psycho-Neuro-Immune-Metabolic Connection

“…It can be hypothesized that the microvascular damage can contribute to cardiac involvement and a capillaroscopic study may help preventing cardiovascular involvement [ 26 ] also in anorexia nervosa. Sekaninova N. et al suggest that complex non-invasive assessment of cardiovascular autonomic regulation—cardiac vagal control, sympathetic vascular activity, and cardiovascular reflex control—could represent a promising tool for early diagnosis, personalized therapy, and monitoring of therapeutic interventions in anorexia nervosa particularly at a vulnerable adolescent age [ 27 ]. Early diagnosis of AN is a critical prognostic factor and heart rate variability may provide a unique assessment for the presence of AN being markedly and consistently altered in these patients [ 28 , 29 ].…”

“…Recently, Sekaninova et al reviewed evidence of abnormalities in the immune system and dysfunction in multiple neuroendocrine axes that togheter may help to explain the link between AN and its cardiovascular complications [ 27 ]. Various neurological mechanisms are involved in the pathogenesis of AN to which the intricate relation of its psychological component also contribute.…”