In the Journals

Bulimia nervosa associated with increased risk for cardiovascular diseases among women

Findings of a 12-year study from Canada suggest a link between bulimia nervosa and the risk for any cardiovascular disease, as well as death, among women. Due to these associations, women with a history of the disorder should be screened regularly for ischemic cardiovascular disease, and they may benefit from treatment for and prevention of cardiovascular risk factors, according to researchers.

“Bulimia nervosa has a lifetime prevalence of 1.5% and is one of the most common psychiatric diseases in women,” Rasmi M. Tith, RD, MPH, of the School of Public Health and Health Systems at the University of Waterloo in Ontario, and colleagues wrote in JAMA Psychiatry. “Despite a large body of evidence supporting a connection between mental health and later cardiovascular disease, little is known about the association of bulimia nervosa with long-term cardiovascular morbidity. Because cardiovascular disease is responsible for nearly a quarter of the deaths among women, understanding the contribution of bulimia nervosa may be critical to prevention and surveillance efforts.”

The researchers conducted a longitudinal study that used the Maintenance and Use of Data for the Study of Hospital Clientele registry from Quebec. They included 416,709 women hospitalized in Quebec. Of these, 818 women were hospitalized for bulimia nervosa (mean age, 28.3 years). A total of 415,891 women (mean age, 28.3 years) who served as a control group were hospitalized for pregnancy-related events.

Tith and colleagues found women hospitalized for bulimia nervosa had a more than 10-fold greater incidence of cardiovascular disease than those admitted for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs. 1.02 [95% CI, 0.99-1.06] per 1,000 person years). Women hospitalized for bulimia nervosa were 4.25-times more likely (95% CI, 2.98-6.07) to develop any cardiovascular disease and were 4.72-times more likely (95% CI, 2.05-10.84) to die compared with the control group. According to the researchers, Bulimia nervosa was associated with ischemic heart disease, atherosclerosis and cardiac conduction deficits, as well as with a 21.93-times greater risk (95% CI, 9.29-51.74) of myocardial infarction at 2 years of follow up and a 14.13-times greater risk (95% CI, 6.02-33.18) of myocardial infarction at 5 years of follow up.

“Although more studies are needed, the findings from the present study suggest that bulimia nervosa, especially bulimia that requires multiple hospitalizations for treatment, may be associated with a range of cardiovascular disorders,” the researchers wrote. “Bulimia nervosa may be an important contributor to premature cardiovascular disease in women.”

In a related editorial, Katie M. O’Brien, MSPH, PhD, of the National Institute of Environmental Health Sciences, and Alexander P. Keil, MSPH, PhD, of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, highlighted the importance of registry studies such as Tith’s and avenues of potential further research.

“Tith [and colleagues] thoughtfully leverage assumptions in the registry data to provide a convincing argument that women with bulimia may be at increased risk of developing certain CVDs or early death,” they wrote. “Further work could refine these estimates, especially with a well-defined target population, to estimate the true effect of bulimia on CVD.” – by Joe Gramigna

Disclosures: Keil, O’Brien and Tith report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Findings of a 12-year study from Canada suggest a link between bulimia nervosa and the risk for any cardiovascular disease, as well as death, among women. Due to these associations, women with a history of the disorder should be screened regularly for ischemic cardiovascular disease, and they may benefit from treatment for and prevention of cardiovascular risk factors, according to researchers.

“Bulimia nervosa has a lifetime prevalence of 1.5% and is one of the most common psychiatric diseases in women,” Rasmi M. Tith, RD, MPH, of the School of Public Health and Health Systems at the University of Waterloo in Ontario, and colleagues wrote in JAMA Psychiatry. “Despite a large body of evidence supporting a connection between mental health and later cardiovascular disease, little is known about the association of bulimia nervosa with long-term cardiovascular morbidity. Because cardiovascular disease is responsible for nearly a quarter of the deaths among women, understanding the contribution of bulimia nervosa may be critical to prevention and surveillance efforts.”

The researchers conducted a longitudinal study that used the Maintenance and Use of Data for the Study of Hospital Clientele registry from Quebec. They included 416,709 women hospitalized in Quebec. Of these, 818 women were hospitalized for bulimia nervosa (mean age, 28.3 years). A total of 415,891 women (mean age, 28.3 years) who served as a control group were hospitalized for pregnancy-related events.

Tith and colleagues found women hospitalized for bulimia nervosa had a more than 10-fold greater incidence of cardiovascular disease than those admitted for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs. 1.02 [95% CI, 0.99-1.06] per 1,000 person years). Women hospitalized for bulimia nervosa were 4.25-times more likely (95% CI, 2.98-6.07) to develop any cardiovascular disease and were 4.72-times more likely (95% CI, 2.05-10.84) to die compared with the control group. According to the researchers, Bulimia nervosa was associated with ischemic heart disease, atherosclerosis and cardiac conduction deficits, as well as with a 21.93-times greater risk (95% CI, 9.29-51.74) of myocardial infarction at 2 years of follow up and a 14.13-times greater risk (95% CI, 6.02-33.18) of myocardial infarction at 5 years of follow up.

“Although more studies are needed, the findings from the present study suggest that bulimia nervosa, especially bulimia that requires multiple hospitalizations for treatment, may be associated with a range of cardiovascular disorders,” the researchers wrote. “Bulimia nervosa may be an important contributor to premature cardiovascular disease in women.”

In a related editorial, Katie M. O’Brien, MSPH, PhD, of the National Institute of Environmental Health Sciences, and Alexander P. Keil, MSPH, PhD, of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, highlighted the importance of registry studies such as Tith’s and avenues of potential further research.

“Tith [and colleagues] thoughtfully leverage assumptions in the registry data to provide a convincing argument that women with bulimia may be at increased risk of developing certain CVDs or early death,” they wrote. “Further work could refine these estimates, especially with a well-defined target population, to estimate the true effect of bulimia on CVD.” – by Joe Gramigna

Disclosures: Keil, O’Brien and Tith report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.