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Cardiovascular disorders in anorexia nervosa and potential therapeutic targets

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Abstract

Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in eating habits. AN may be divided into two types: a “binge-eating/purging type” during which the individual regularly engages in overeating and then purging behavior, and a “restricting type”, in which she does not. AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN exhibit an enhanced mortality rate as compared with age-matched healthy subjects, which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Cardiovascular complications of AN can be present in up to 80 % of cases, and among them alterations in cardiac electrical activity, structure and hemodynamics have been reported as causes of morbidity and mortality. The objective of this brief review is to summarize current knowledge on the main cardiovascular complications of AN, their underlying mechanisms and the possible therapeutic approaches.

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References

  1. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  2. Sullivan PF (1995) Mortality in anorexia nervosa. Am J Psychiatry 152:1073–1074

    PubMed  CAS  Google Scholar 

  3. Neumärker KJ (1997) Mortality and sudden death in anorexia nervosa. Int J Eat Disord 21:205–212

    Article  PubMed  Google Scholar 

  4. Sharp CW, Freeman CPL (1993) The medical complication of anorexia nervosa. Br J Psychiatry 162:452–462

    Article  PubMed  CAS  Google Scholar 

  5. Thurston J, Marks P (1974) Electrocardiographic abnormalities in patients with anorexia nervosa. Br Heart J 36:719–723

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Kanbur NO, Goldberg E, Pinhas L, Hamilton RM, Clegg R, Katzman DK (2009) Second-degree atrioventricular block (Mobitz type I) in an adolescent with anorexia nervosa: intrinsic or acquired conduction abnormality. Int J Eat Disord 42:575–578

    Article  PubMed  Google Scholar 

  7. Bravender T, Kanter R, Zucker N (2006) Anorexia nervosa and second-degree atrioventricular block (type I). Int J Eat Disord 39:612–615

    Article  PubMed  Google Scholar 

  8. Panagiotopoulos C, McCrindle BW, Hick K, Katzman DK (2000) Electrocardiographic findings in adolescents with eating disorders. Pediatrics 105:1100–1105

    Article  PubMed  CAS  Google Scholar 

  9. Folino AF, Tokajuk B, Porta A, Romano S, Cerutti S, Volta SD (2005) Autonomic modulation and clinical outcome in patients with chronic hearth failure. Int J Cardiol 100:247–251

    Article  PubMed  Google Scholar 

  10. La Rovere MT, Bigger JT, Marcus FI, Mortara A, Schwartz PJ, For the ATRAMI Investigators (1998) Baroreflex sensitivity and heart rate variability in prediction of total cardiac mortality after myocardial infarction. Lancet 351:478–484

    Article  PubMed  Google Scholar 

  11. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 93:1043–1065

    Article  Google Scholar 

  12. Petretta M, Bonaduce D, Scalfi L, de Filippo E, Marciano F, Migaux ML et al (1997) Heart rate variability as a measure of autonomic nervous system function in anorexia nervosa. Clin Cardiol 20:219–224

    Article  PubMed  CAS  Google Scholar 

  13. Galetta F, Franzoni F, Prattichizzo F, Rolla M, Santoro G, Pentimone F (2003) Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health 32:416–421

    Article  PubMed  Google Scholar 

  14. Kreipe RE, Goldstein B, DeKing DE, Tipton R, Kempski MH (1994) Heart rate power spectrum analysis of autonomic dysfunction in adolescents with anorexia nervosa. Int J Eat Disord 16:159–165

    Article  PubMed  CAS  Google Scholar 

  15. Bär KJ, Boettger S, Wagner G, Wilsdorf C, Gerhard UJ, Boettger MK et al (2006) Changes of pain perception, autonomic function, and endocrine parameters during treatment of anorectic adolescents. J Am Acad Child Adolesc Psychiatry 45:1068–1076

    Article  PubMed  Google Scholar 

  16. Jacoangeli F, Mezzasalma FS, Canto G, Jacoangeli F, Colica C, de Lorenzo A et al (2013) Baroreflex sensitivity and heart rate variability are enhanced in patients with anorexia nervosa. Int J Cardiol 162:263–264

    Article  PubMed  Google Scholar 

  17. Rechlin T, Weis M, Ott C, Bleichner F, Joraschky P (1998) Alterations of autonomic cardiac control in anorexia nervosa. Biol Psychiatry 43:358–363

    Article  PubMed  CAS  Google Scholar 

  18. Melanson EL, Donahoo WT, Krantz MJ, Poirier P, Mehler PS (2004) Resting and ambulatory hearth rate variability in chronic anorexia nervosa. Am J Cardiol 94:1217–1220

    Article  PubMed  Google Scholar 

  19. Mazurak N, Enck P, Muth E, Teufel M, Zipfel S (2011) Heart rate variability as a measure of cardiac autonomic function in anorexia nervosa: a review of the literature. Eur Eat Disorders Rev 19:87–99

    Article  Google Scholar 

  20. Dec GW, Biederman J, Hougen TJ (1987) Cardiovascular findings in adolescent inpatients with anorexia nervosa. Psychosom Med 49:285–290

    Article  PubMed  CAS  Google Scholar 

  21. Olivares JL, Vàzquez M, Fleta J, Moreno LA, Pérez-Gonzaléz JM, Bueno M (2005) Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr 164:383–386

    Article  PubMed  Google Scholar 

  22. Vàzquez M, Jl Olivares, Fleta J, Lacambra I, González M (2003) Cardiac disorders in young women with anorexia nervosa. Rev Esp Cardiol 56:669–673

    Article  PubMed  Google Scholar 

  23. Nudel DB, Gootman N, Nussbaum MP, Shenker R (1984) Altered exercise performance and abnormal sympathetic responses to exercise in patients with anorexia nervosa. J Pediatr 105:34–37

    Article  PubMed  CAS  Google Scholar 

  24. Mont L, Castro J, Herreros B, Paré C, Azqueta M, Magriña J (2003) Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 42:808–813

    Article  PubMed  Google Scholar 

  25. Bednar MM, Harrigan EP, Anziano RJ, Camm AJ, Ruskin JN (2001) The QT interval. Prog Cardiovasc Dis 43(5 suppl 1):1–45

    PubMed  CAS  Google Scholar 

  26. Powers PS, Schocken DD, Feld J, Holloway JD, Boyd F (1991) Cardiac function during weight restoration in anorexia nervosa. Int J Eating Dis 10:521–530

    Article  Google Scholar 

  27. Gottdiener JS, Gross HA, Henry WL, Borer JS, Ebert MH (1978) Effects of self-induced starvation on cardiac size and function in anorexia nervosa. Circulation 58:425–433

    Article  PubMed  CAS  Google Scholar 

  28. Roche F, Estour B, Kadem M, Millot L, Pichot V, Duverney D et al (2004) Alteration of the QT rate dependence in anorexia nervosa. PACE 27:1099–1104

    Article  PubMed  Google Scholar 

  29. Takimoto Y, Yoshiuchi K, Kumano H, Yamanaka G, Sasaki T, Suematsu H et al (2004) QT interval and QT dispersion in eating disorders. Psychoter Psychosom 73:324–328

    Article  Google Scholar 

  30. Casiero D, Frishman WH (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14:227–231

    Article  PubMed  Google Scholar 

  31. Isner JM, Roberts WC, Heymsfield SB, Yager J (1985) Anorexia nervosa and sudden death. Ann Intern Med 102:49–52

    Article  PubMed  CAS  Google Scholar 

  32. Lesinskiene S, Barkus A, Ranceva N, Dembinskas A (2008) A meta-analysis of heart rate and QT interval alteration in anorexia nervosa. World J Biol Psychiatry 9:86–91

    Article  PubMed  Google Scholar 

  33. Kunkler K (2002) Acquired long QT syndrome: risk assessment, prudent prescribing and monitoring, and patient education. J Am Acad Nurse Pract 14:382–389

    Article  PubMed  Google Scholar 

  34. Conri C, Roudaut R, Ducloux G, Fleury B, Moreau F (1989) Étude échocardiographique au cours de l’anorexie mentale. Presse Med 18:806–808

    PubMed  CAS  Google Scholar 

  35. de Simone G, Scalfi L, Galderisi M, Celentano A, Di Biase G, Tammaro P et al (1994) Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 71:287–292

    Article  PubMed  PubMed Central  Google Scholar 

  36. Franzoni F, Galetta F, Cupisti A, Rolla M, Santoro G, Pentimone F (2003) Ultrasonic tissue characterization of the myocardium in anorexia nervosa. Acta Paediatr 92:297–300

    Article  PubMed  CAS  Google Scholar 

  37. Romano C, Chinali M, Pasanisi F, Greco R, Celentano A, Rocco A (2003) Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa. Am J Clin Nutr 77:308–312

    PubMed  CAS  Google Scholar 

  38. Galetta F, Franzoni F, Cupisti A, Belliti D, Prattichizzo F, Rolla M (2002) QT interval dispersion in young women with anorexia nervosa. J Pediatr 140:456–460

    Article  PubMed  Google Scholar 

  39. Ulger Z, Gürses D, Ozyurek AR, Arikan C, Levent E, Aydoğdu S (2006) Follow-up of cardiac abnormalities in female adolescents with anorexia nervosa after refeeding. Acta Cardiol 61:43–49

    Article  PubMed  Google Scholar 

  40. Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A (2005) Medical findings in outpatients with anorexia nervosa. Arch Int Med 165:561–566

    Article  Google Scholar 

  41. Shamim T, Golden NH, Arden M, Filiberto L, Shenker IR (2003) Resolution of vital sign instability: an objective measure of medical stability in anorexia nervosa. J Adolesc Health 32:73–77

    Article  PubMed  Google Scholar 

  42. Moodie DS, Salcedo E (1983) Cardiac function in adolescents and young adults with anorexia nervosa. J Adolesc Health Care 4:9–14

    Article  PubMed  CAS  Google Scholar 

  43. St John Sutton MG, Plappert T, Crosby L, Douglas P, Mullen J, Reichek N (1985) Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa. Circulation 72:991–1000

    Article  PubMed  CAS  Google Scholar 

  44. Katzman DK (2005) Medical complications in adolescent with anorexia nervosa: a review of the literature. Int J Eat Disord 37:S52–S59

    Article  PubMed  Google Scholar 

  45. Birmingham CL, Gritzner S (2007) Heart failure in anorexia nervosa: case report and review of literature. Eat Weight Disord 12:e7–e10

    Article  PubMed  CAS  Google Scholar 

  46. Davidson A, Anisman PC, Eshaghpour E (1992) Heart failure secondary to hypomagnesemia in anorexia nervosa. Pediatr Cardiol 13:241–242

    Article  PubMed  CAS  Google Scholar 

  47. Ohwada R, Hotta M, Kimura H, Takagi S, Matsuda N, Nomura K et al (2005) Ampulla cardiomyopathy after hypoglycemia in three young female patients with anorexia nervosa. Intern Med 44:228–233

    Article  PubMed  Google Scholar 

  48. Ono T, Kasaoka S, Fujita M, Yamashita S, Kumagai K, Kaneda K et al (2009) Complete recovery from severe myocardial dysfunction in a patient with anorexia nervosa. J Cardiol 54:480–484

    Article  PubMed  Google Scholar 

  49. Nicholls D, Hudson L, Mahomed F (2011) Managing anorexia nervosa. Arch Dis Child 96:977–982

    Article  PubMed  Google Scholar 

  50. Mehanna HM, Moledina J, Travis J (2008) Refeeding syndrome: what it is, and how to prevent and treat it. BMJ 336:1495–1498

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ornstein RM, Golden NH, Jacobson MS, Shenker IR (2003) Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring. J Adolesc Health 32:83–88

    Article  PubMed  Google Scholar 

  52. National Institute for Health and Clinical Excellence (NICE) (2006) Nutrition support in adults. NICE Clin Guidel 32:15–22

  53. National Collaborating Centre for Mental Health, National Institute of Clinical Excellence (2004) Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. NICE Clin Guidel 9:91–94

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Authors and Affiliations

  1. Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Via O. Raimondo, 8, 00173, Rome, Italy

    Giovanni Di Cola & Ferdinando Iellamo

  2. Unità di Cardiologia Osp. S. Andrea, II Facoltà di Medicina, Università di Roma La Sapienza, Rome, Italy

    Francesca Jacoangeli

  3. Dipartimento di Biomedicina, Università di Roma Tor Vergata, Rome, Italy

    Fabrizio Jacoangeli

  4. Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy

    Ferdinando Iellamo

  5. Università Telematica San Raffaele, Rome, Italy

    Mauro Lombardo

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  1. Giovanni Di Cola
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  2. Francesca Jacoangeli
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  3. Fabrizio Jacoangeli
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  4. Mauro Lombardo
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  5. Ferdinando Iellamo
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Correspondence to Ferdinando Iellamo.

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Di Cola, G., Jacoangeli, F., Jacoangeli, F. et al. Cardiovascular disorders in anorexia nervosa and potential therapeutic targets. Intern Emerg Med 9, 717–721 (2014). https://doi.org/10.1007/s11739-014-1107-2

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  • DOI: https://doi.org/10.1007/s11739-014-1107-2

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