Long-Term Risk of Heart Disease and Death among Women with BN

A Canadian study follows the risk over 12 years.

The short-term risks for cardiovascular complications among women with BN are well known, but few studies have taken a longer view. What happens as time passes?  Does the risk increase or lessen?

To assess the risk of cardiovascular disease among women with BN, a group of Canadian researchers headed by Rasmi M. Tith, RD, MPH, designed a 12-year follow-up study of 416,709 Canadian women hospitalized with BN and 415,891women without BN hospitalized with pregnancy-related conditions (JAMA Psychiatry. 2020. 77:44).  The participants were followed from their first admission, and follow-up ended at the first incidence of cardiovascular disease, death, or the end of the study on March 31, 2018, whichever occurred first. The authors’ results suggested that women with BN can benefit from closer management of cardiovascular complications after treatment, and should be regularly screened for risk of ischemic cardiovascular disease.

The risk for cardiovascular disease among BN patients was greater early on

The women were hospitalized from 2006 to 2018 in Quebec, Canada. The final study group included 818 women with BN and 415,891 women without BN but with pregnancy-related problems.  Initially, the women hospitalized with BN had a greater initial incidence of cardiovascular disease than the comparison group.

The risk for developing cardiovascular disease among the women with BN was greatest in the early months of follow-up, and later became similar to that among the women with pregnancy-related hospitalizations. In the early years of follow-up, women hospitalized with BN had a 5.48 times greater risk of developing cardiovascular disease than did the women hospitalized for pregnancy-related problems. The authors concluded that BN might be an important contributor to premature cardiovascular disease in women. The authors also recorded 16 deaths among women in the study group and 299 among women with pregnancy-related hospitalizations.

According to the authors, in addition to immediate complications such as oropharyngeal and gastrointestinal disorders, vomiting and use of laxatives can lead to electrolyte imbalances, and can increase the short-term risk of arrhythmias (J Eat  Disord. 2015; 3:25866627). In addition, damage to cardiac myocytes, or muscle cells, can lead to congestive heart failure, ventricular arrhythmias, or even to sudden cardiac death. Development of psychosocial stress and anxiety  are additional risk factors for cardiovascular disease and death (Am J Hypertens. 2015; 28:1295; Int J Eat Disord. 2005; 38:99).

The key to changing the statistics, according to the authors, is closely following BN patients at risk. This includes watching for metabolic changes, such as low estrogen levels, and being aware of patients’ adverse lifestyles, including heavy cigarette smoking, or excess drug and alcohol use, which also contribute to development of cardiovascular disease.

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