QUESTIONS AND ANSWERS: Long-Term Effects of Anorexia Nervosa on the Heart

Q. We don’t hear much about the long-term effects of AN on the heart. Is there any new information? (C.B., Sacramento, CA)

A. We know that medical problems and high risk of death are important parts of AN, and a substantial part of those risks seem to be related to heart problems. Short-term studies in adolescents with AN have shown numerous cardiac changes. In the short run, some of those problems seem to diminish with treatment. What happens over longer periods?

A recent study that followed AN patients first diagnosed as adolescents and then revisited them 20 years later gives us some answers. Flamarique and colleagues (J Eat Disord. 2022. 10:22) reported on a small sample of people who had AN as adolescents. The study included 29 people who had had AN and 30 matched healthy comparison participants, and follow-up occurred an average of 22 years after entering treatment. The mean age when the patients were first seen was 13.58 years, and the mean BMI at that time was 15.9 mg/kg2.

Low weight and cardiac structural abnormalities were important clues to underlying cardiac problems. The main measures used were an electrocardiogram and an echocardiogram to assess the electrical function and structure of the heart. At follow-up, 18 of the 29 AN patients were in full recovery. However, 4 patients had AN; 2 had atypical AN; 2 were diagnosed with partially remitted AN; and 2 had atypical BN. Patients with AN diagnoses had decreased dimensions and mass of the left ventricle and left atrium.

The results showed that the hearts of those who had fully recovered were indistinguishable from the controls, who had never had an ED. In those who remained at low weights, some structural changes persisted, but ECG abnormalities were not noted.

This study is small, and in that sense, conclusions should be preliminary. But it is clinically useful (and reassuring), in that it provides evidence that recovery reverses physical complications of AN and (one would presume diminishes risk over the long term).

— SC

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