By Lisa Rapaport

(Reuters Health) – Women hospitalized for bulimia may be more likely to develop heart disease and die prematurely, a recent study suggests.

Researchers compared 818 women hospitalized for bulimia and more than 415,000 women hospitalized for pregnancy-related events. At the start, the women were 28 years old on average. During the next 12 years, the women hospitalized for bulimia had more than four times the risk of having events like heart attacks or strokes or dying than the other women in the study.

“Bulimia is known to have acute implications for the heart, but the long term impact has not been previously studied,” said Dr. Nathalie Auger, of the University of Montreal Hospital Research Centre.

“This study shows that bulimia has implications for a wide range of cardiovascular disorders later in life, as well as death,” Auger, senior author of the study, said by email. “Patients with bulimia may not know about these risks.”

Bulimia nervosa is one of the most common psychiatric disorders in women, with a lifetime prevalence of about 1.5%, Auger and colleagues note in JAMA Psychiatry.

The disease is characterized by episodes of binge eating followed by purging, including self-induced vomiting, use of laxatives, excessive exercise, or restricted food intake, the study team notes. These behaviors can increase the risk of heart rhythm disorders, congestive heart failure, and sudden cardiac death.

Bulimia is also associated with psychosocial stress and anxiety, both of which are independent risk factors for heart disease and premature death, the study team notes.

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Among every 1,000 patients with bulimia, roughly 10 will develop heart disease each year and roughly three will die, researchers calculated. That compares to roughly one heart disease case every year, and one death every 10 years, for every 1,000 women without bulimia.

Women hospitalized with bulimia were more than five times more likely to have heart attacks and more than six times more likely to have coronary artery disease. They were also almost seven times more likely to develop hardening of the arteries.

One limitation of the study is that researchers lacked data on women with milder forms of bulimia that didn’t require hospitalization, the study team notes. Another drawback is that they didn’t know how long women had bulimia, or whether they had a history of relapse or remission, both of which might impact heart health.

“By looking at hospital records over an extended period of time, the authors had access to quality information on a large number of people,” said Katie O’Brien, co-author of an editorial accompanying the study and a staff scientist at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina.

“This was crucial for a study of bulimia nervosa, as it is a rare disorder (estimated 1.5% lifetime prevalence) and the authors were considering health-related events over many years,” O’Brien said by email.

However, “because they were limited to studying women who had been admitted to the hospital, it is not clear if the associations they observed would be the same in a more general population or how the possible effects of bulimia on cardiovascular disease risk would change as women aged,” O’Brien added.

SOURCE: JAMA Psychiatry, online October 16, 2019.