Eating disorders and cardiovascular outcomes: A systematic review with meta-analysis

Abstract

Background and objective

To conduct a literature review to assess the association between eating disorders (ED), cardiovascular outcomes and all-cause mortality.

Methods

Observational studies that presented a measure of association between mortality (or cardiac outcomes) and EDs in adult or adolescent patients were included. The databases PubMed, Web of Science, EMBASE, Livivo, Scopus, PsycINFO and Lilacs were consulted. The random effect was adopted to group the findings of the primary studies in the meta-analysis using the Hazzard Ratio (HR) as a measure of association.

Results

The meta-analysis with 50,263 patients with ED showed a higher risk of mortality from all causes in patients compared to controls. The associated risk of death from all causes was higher with anorexia (AN) compared to other ED (AN: HR 5.38; 95 %CI 4.42 to 6.56; binge ED: HR 2.48; 95 %CI 1.13 to 5.46; bulimia: HR 2.21; 95 %CI 1.70 to 2.87). Additionally, one study demonstrated an association between bulimia and an increased risk of developing cardiovascular disease (HR 4.25; 95 %CI 2.98 to 6.07) and another study showed a higher risk of cardiovascular events in people with bulimia than in healthy controls (HR 1.4; 95 %CI 0.7 to 2.8). Finally, a higher risk of cardiovascular events in people with AN (HR 10.4; 95 %CI 2.6 to 41.6) was demonstrated in one study, when compared to healthy controls.

Conclusions

There is an association between EDs and all-cause mortality, with AN being associated with the highest risk, followed by binge ED and bulimia.