Does bulimia nervosa increase long-term risk of CVD and death?

©terovesalainen - stock.adobe.com

The physical behaviors associated with binge eating and purging (bulimia nervosa) are known to have a potentially negative short-term effect on cardiovascular health. Results of a new study suggest that the condition also may be associated with a long-term risk of cardiovascular disease (CVD) and death.

Published in JAMA Psychiatry, the findings are from a Canadian longitudinal cohort study. The comparison groups were women in Quebec hospitalized for bulimia nervosa and for pregnancy-related events. More than 400,000 participants were included and followed up for 12 years to identify incidences of CVD and death.

Methods
The authors used the Maintenance and Use of Data for the Study of Hospital clientele registry, which includes discharge abstracts of all hospitalizations in Quebec. The women in the bulimia nervosa group had been hospitalized for it between 2006 and 2016. The women in the other group were hospitalized during the same period for delivery of a live or stillborn infant, abortion, ectopic pregnancy, or formation of a hydatidiform mole. That group was considered representative of most women in Quebec because 99% of deliveries and a significant proportion of other pregnancy events occur in hospitals.

The researchers used Cox proportional hazards regression to estimate hazard ratios (HRs) and confidence intervals (Cis) to assess the association between bulimia nervosa and future outcomes after adjustment for patient characteristics. Outcomes included myocardial infarction (MI), other ischemic heart disease, cerebrovascular disease, and atherosclerosis. Because the number of individual events was too low, the disorders could not be analyzed separately. The authors also looked at all-cause mortality.

Results
Based on nearly 3 million person-years of follow-up, the researchers found that women hospitalized for bulimia nervosa had a higher incidence of CVD than those hospitalized for pregnancy-related events (10.34 [95% CI, 7.77-13.756] vs 1.02 [95% CI, 0.99-1.06] per 1000 person-years). Incidence of future CVD was even higher for women with three or more bulimia admissions (25.13 [95% CI, 13.52-46.70] per 1000 person-years).

Risk of CVD and of death were 4.25 times and 4.72 time higher, respectively, in women hospitalized for bulimia nervosa than in the comparison group. Bulimia nervosa was also associated with 21.93 times the risk of MI at 2-year follow-up and 14.13 times the risk at 5-year follow-up.

Conclusion
The findings from the study, the authors said, “suggest that bulimia nervosa, especially bulimia that requires multiple hospitalizations for treatment, may be associated with a range of cardiovascular disorders. Bulimia nervosa may be an important contributor to premature cardiovascular disease in women.” They recommend that clinicians counsel women with the condition about the increased risk of CVD and death in the first decade after the index admission for bulimia and screen them for prevention and treatment of cardiovascular risk factors.