Cardiac Risk and Disordered Eating: Decreased R Wave Amplitude in Women with Bulimia Nervosa and Women with Subclinical Binge/Purge Symptoms

Abstract

The purpose of the present study was threefold. First, we examined whether women with bulimia nervosa (n = 12) and women with subthreshold binge/purge symptoms (n = 20) showed decreased mean R wave amplitude, an indicator of cardiac risk, on electrocardiograph compared to asymptomatic women (n = 20). Second, we examined whether this marker was pervasive across experimental paradigms, including before and after sympathetic challenge tasks. Third, we investigated behavioural predictors of this marker, including binge frequency and purge frequency assessed by subtype (dietary restriction, excessive exercise, self-induced vomiting, and laxative abuse). Results of a 3 (ED symptom status) × 5 (experimental condition) mixed factorial ANCOVA (covariates: body mass index, age) indicated women with bulimia nervosa and women with subclinical binge/purge symptoms demonstrated significantly reduced mean R wave amplitude compared to asymptomatic women; this effect was pervasive across experimental conditions. Multiple regression analyses showed binge and purge behaviours, most notably laxative abuse as a purge method, predicted decreased R wave amplitude across all experimental conditions. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women

“…19 Women with an altered R-wave amplitude in the study were more likely to have sudden ventricular arrhythmias. 19 However, not all studies support an acute association of bulimia with changes in the myocardium. A recent study in Denmark of 531 women with bulimia and 125 women without found no evidence of an association of bulimia with QT prolongation or with immediate cardiac events and all-cause mortality.…”

“…1 Electrical conduction defects in bulimia coincide with electrolyte imbalance and hypokalemia. [19][20][21] In women diagnosed with severe bulimia and hypokalemia, QT interval prolongation and repolarization abnormalities may lead to sudden acute ventricular arrhythmias and death. 21 A study of 52 women diagnosed with bulimia in the United States who binged and purged found a lower R-wave amplitude on the electrocardiogram, indicating reduced cardiac contractile force and signaling.…”

“…23 Cyclical patterns of binging followed by restrictive eating or purging is thought to be responsible for these metabolic alterations. 19,23 Average binge episodes can be excessive and include processed foods with caloric intakes of 2415 kcal on average, although intakes of 4000 kcal per binge are also possible. 24 Excess consumption of fat and carbohydrates can influence lipoprotein metabolism and have atherogenic effects that are associated with the risk of cardiovascular disease.…”

“…Most of the literature focuses on acute consequences, including immediate hemodynamic changes and electrical conduction defects due to excessive purging and fluid loss. [19][20][21] Bulimia is associated with reduced blood pressure, pulse rate, and oxygen saturation during active disease. 1 Electrical conduction defects in bulimia coincide with electrolyte imbalance and hypokalemia.…”

Assessment and management of cardiovascular complications in eating disorders

“…Binge episodes characteristically involve highly processed foods and contain an average of 2415 kcal per episode [ 63 ]. The prevalence of hypercholesterolaemia is increased among women with BN (estimates range from 19 to 48%) and it is thought that the binge-restrict cycle is responsible for this derangement which represents a major risk factor for cardiovascular disease [ 64 , 65 ].…”