Bulimia nervosa in women linked to CVD, death

Bulimia nervosa carries an increased risk of CVD and death in women, according to a study published online Oct. 16 in JAMA Psychiatry.

In the study, Nathalie Auger, MD, M.Sc., FRCPC, of the Institut National de Sante Publique du Quebec, Montreal, QC, Canada and colleagues noted that while bulimia nervosa has already been associated with short-term cardiovascular complications among female patients, the long-term risk of CVD and mortality in females had not yet been determined. Using Quebec registry data, the researchers followed 818 women who had been hospitalized for bulimia and 415,891 women who had been hospitalized for pregnancy-related events, such as delivery of a live or stillborn infant, abortion and ectopic pregnancy.

The mean age of women in both groups was 28.3 years. The control group was chosen, the study authors noted, because its subjects were believed to reflect the majority of women that age in Quebec.

Patients were followed for a period of 12 years, from 2006 to 2018. The researchers found that the women who had been hospitalized for bulimia had a greater risk of CVD (10.34 per 1,000 person-years) than those who had been hospitalized for pregnancy-related events (1.02 per 1,000 person-years). The Iikelihood of future CVD was deemed higher for women who had had three or more hospital admissions for bulimia, at 25.13 per 1,000 person-years.

Among other findings of the study, women hospitalized for bulimia nervosa were determined to be 4.25 times more likely to contract any form of CVD and 4.72 times more likely to die than patients in the control group. Bulimia nervosa was found to be associated with ischemic heart disease, artherosclerosis, and cardiac conduction defects, as well as with 21.93 times the risk of myocardial infarction at two years of follow-up and 14l13 times the risk of myocardial infarction at five years of follow-up.

“Our findings suggest that women with a history of bulimia nervosa should be informed of an increased risk of cardiovascular disease and death in the first decade after the index admission for bulimia,” the study authors wrote. “These women may benefit from screening for prevention and treatment of cardiovascular risk factors.”

Meanwhile, in an accompanying editorial , Katie M. O’Brien, MSPH, PhD and Alexander P. Keil, MSPH, PhD, of the National Institute of Environmental Health Sciences acknowledged the usefulness of registry data such as that included in the study when data sources are limited.

However, they cautioned that additional research is needed to “refine these estimates, especially with a well-defined target population, to estimate the true effect of bulimia on CVD.”

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