The risk of cardiovascular disease skyrockets for women who have been hospitalized for bulimia nervosa, a study in JAMA Psychiatry reports. The risk for bulimia and heart disease is greatest in the first two years after hospitalization and remains high for another three years before disappearing at the 10-year mark.
Bulimia and Heart Disease
“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,” wrote Rasmi M. Tith, R.D., M.P.H., of the University of Waterloo in Ontario and colleagues. “These women may benefit from screening for prevention and treatment of cardiovascular risk factors.”
The study followed more than 416,000 women for up to 12 years from 2006 to 2018. Of the patients, 818 were hospitalized for bulimia, and the rest were hospitalized for pregnancy-related events such as the delivery of a live or stillborn infant, abortion, or pregnancy outside the uterus (ectopic pregnancy). The average age of the women at hospitalization was 28 years.
“The comparison group was representative of most women in the province … because 99% of deliveries and a significant proportion of other pregnancy events occur in hospitals,” the researchers wrote.
Compared with women who had been hospitalized for pregnancy-related events, women who had been hospitalized for bulimia had nearly 22 times the risk of a heart attack within two years of hospitalization and more than 14 times the risk at five years. A high correlation between bulimia and heart disease.
Over the entire follow-up, they had more than four times the risk of any cardiovascular disease, including six times the risk of heart attack, seven times the risk of ischemic heart disease (heart problems caused by narrowed heart arteries), and seven times the risk of atherosclerosis.
They also had five times the risk of death. Those who had multiple hospitalizations for bulimia had a higher risk of cardiovascular disease and death than those who had been hospitalized only once.
The researchers noted that bulimia has been associated with metabolic changes such as changes in lipids that may affect the risk of cardiovascular disease. They added that bulimia may cause endocrine abnormalities such as low estrogen levels, which may also increase cardiovascular risk.
“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 concluded. “Bulimia nervosa may be an important contributor to premature cardiovascular disease in women.” 
Sources: Tith, R. M., Paradis, G., Potter, B. J., Low, N., Healy-Profitós, J., He, S., & Auger, N. (2019). Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2019.2914  O’Brien, K. M., & Keil, A. P. (2019). Design and Interpretation Considerations in Registry-Based Studies. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2019.2234
About the Author:
Mark S. Gold, M.D. is Professor (Adjunct), Washington University in St Louis, School of Medicine, Department of Psychiatry, and National Council, Washington University in St. Louis, School of Medicine, Institute for Public Health. He served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2015.
Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor. Prior to assuming the position as Chair, he was a Distinguished Service Professor in the Departments of Psychiatry, Neuroscience, Anesthesiology, and Community Health and Family Medicine at the University of Florida College of Medicine.
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Published October 24, 2019, on EatingDisorderHope.com
Reviewed & Approved on October 24, 2019, by Jacquelyn Ekern MS, LPC