Anorexia nervosa and heart disease: a systematic review

Abstract

Anorexia nervosa (AN) is an eating disorder that most frequently afflicts females in adolescence. In these subjects, cardiovascular complications are the main cause of morbidity and mortality. Aim of this review is to analyze the hemodynamic, pro-arrhythmic and structural changes occurring during all phases of this illness, including re-feeding. A systematic literature search was performed on studies in the MEDLINE database, from its inception until September 2017, with PUBMED interface focusing on AN and cardiovascular disease. This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital. In addition, reduced cardiac mass, with smaller volumes and decreased cardiac output, may be found. Furthermore, mitral prolapse and a mild pericardial effusion may occur, the latter due to protein deficiency and low levels of thyroid hormone. In anorectic patients, some cases of hypercholesterolemia may be present; however, conclusive evidence that AN is an atherogenic condition is still lacking, although a few cases of myocardial infarction have been reported. Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications.

Role of Neuroendocrine, Immune, and Autonomic Nervous System in Anorexia Nervosa-Linked Cardiovascular Diseases

“…The highest incidence rate subgroup for AN includes adolescent girls aged 15–19 years, which accounts for about 40% of all identified cases [ 2 ]. Moreover, patients suffering from AN are characterised by neuroendocrine, immune, and autonomic nervous system (ANS) dysregulation resulting in cardiovascular complications and potentially leading to increased morbidity and mortality [ 3 , 4 , 5 ]. Cardiovascular complications occur in up to 80% of patients with AN, and account for up to 30% of mortality [ 6 ].…”

“…For example, sinus bradycardia (i.e., resting heart rate less than 50 beats per minute), relatively low arterial blood pressure (hypotension usually lower than 100/50 mmHg), prolonged QT interval, atherosclerosis, etc. are associated with AN even at adolescent age [ 5 ]. Despite the fact that some of these changes could represent adaptation to poor nutrition, the origin and pathogenesis are not absolutely clear (according to reviews by Mazurak et al [ 7 ] and Giovinazzo et al [ 5 ]).…”

“…are associated with AN even at adolescent age [ 5 ]. Despite the fact that some of these changes could represent adaptation to poor nutrition, the origin and pathogenesis are not absolutely clear (according to reviews by Mazurak et al [ 7 ] and Giovinazzo et al [ 5 ]). Thus, we suggest that the issue of precise and sensitive cardiovascular risk assessment is crucial, especially in adolescence.…”

School health class associated with reduced odds of eating disorder symptoms in American adolescents

“…The negative physical and mental health effects of eating disorders and disordered eating behaviors have been well documented (Conti et al, ; Fichter, Quadflieg, Crosby, & Koch, ; Forney, Buchman‐Schmitt, Keel, & Frank, ; Giovinazzo et al, ; Herpertz‐Dahlmann et al, ; Tabler & Utz, ), yet eating disorder symptoms remain prevalent. While extensive research has been conducted on treating these disorders, scarce studies have examined the role that in‐school education on nutrition and exercise plays in prevention.…”

“…The negative physical and mental health effects of eating disorders and disordered eating behaviors have been well documented (Conti et al, 2017;Fichter, Quadflieg, Crosby, & Koch, 2017;Forney, Buchman-Schmitt, Keel, & Frank, 2016;Giovinazzo et al, 2019;Herpertz-Dahlmann et al, 2018;Tabler & Utz, 2015), yet eating disorder symptoms remain prevalent. While extensive research has been conducted on treating these disorders, scarce studies have examined the role that in-school education on nutrition and exercise plays in Given that the risk of disordered eating behaviors increases throughout adolescence into early adulthood (Neumark-Sztainer, Wall, Larson, & Eisenberg, 2011) and that the average age of diagnosis of an eating disorder is 18 years old (Volpe et al, 2016), prevention efforts may be best administered during adolescence.…”