Bulimia Nervosa Associated With Increased Risk for Long-Term Cardiovascular Disease

Women with a history of bulimia nervosa are at 4 times the risk of developing cardiovascular disease.

A history of bulimia nervosa is significantly linked to an increased risk for cardiovascular events such as myocardial infarction, other ischemic heart disease, atherosclerosis, and conduction disorders, according to a study published in JAMA Psychiatry.1Women with a history of bulimia, therefore, are encouraged to be screened regularly to prevent and treat cardiovascular risk factors.

It is well known that bulimia nervosa is associated with short-term risk for cardiovascular disease (CVD) and death.2 To assess the long-term risk for CVD in women with a history of bulimia, a team of investigators studied 818 women who were hospitalized with at least 1 incidence of bulimia and 415,891 women who were hospitalized for pregnancy-related events (controls). Participants were followed for up to 12 years, and incidences of myocardial infarction, other ischemic heart disease, conduction disorders, pulmonary vascular disease, cerebrovascular disease, atherosclerosis, and coronary care unit admission were collected.

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The mean age of patients included in the study was 28.3 years, and patients were followed for 2,957,677 person-years. Compared with women who were hospitalized for pregnancy-related events, women hospitalized for bulimia had a greater incidence of CVD (1.02 vs 10.34 per 1000 person-years, respectively). Women who were admitted ≥3 times for bulimia-related events had a much greater risk for incidence of future CVD (25.13 per 1000 person-years).

The risk for any CVD and death were 4.25 times and 4.72 times greater, respectively, for women who were hospitalized for bulimia compared with women who were hospitalized for pregnancy-related adversities. Results suggested a significant association between bulimia and ischemic heart disease (hazard ratio [HR], 6.63), atherosclerosis (HR, 6.94), and conduction disorders (HR, 2.99), as well as a risk increase of 21.93 and 14.13 for myocardial infarction after a 2-year and 5-year follow-up, respectively. The increased risk of hospitalization for CVD occurred up to 8 years after the initial hospitalization for bulimia-related complications.

“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,” the investigators reported. “These women may benefit from screening for prevention and treatment of cardiovascular risk factors.”


1. Tith RM, Paradis G, Potter BJ, et al. Association of bulimia nervosa with long-term risk of cardiovascular diseas and mortality among women [published online October 16, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.2914

2. Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009;166(12):1342-1346.

This article originally appeared on Clinical Advisor