Bulimia Nervosa and Risk of Cardiovascular Outcomes: A Longitudinal Matched Cohort Study in Taiwan

Bulimia nervosa (BN), a prevalent eating disorder characterized by recurrent binge-purge cycles, may contribute to long-term cardiovascular (CV) complications. However, evidence regarding these outcomes remains limited. This study investigated CV risks in patients with BN and the risk trajectory across varying follow-up periods by using a nationwide Taiwanese cohort.

Data from the National Health Insurance Research Database (2010-2022) were analyzed. Patients with BN aged 10-59 years were matched with controls at a 1:10 ratio on the basis of sex, age, socioeconomic status, urbanization, and index year through propensity score matching. The composite CV outcomes included atherosclerosis, cardiac arrest, cardiomyopathy, conduction disorders, congestive heart failure, inflammatory heart diseases, ischemic heart diseases, stroke, valve diseases, and venous thromboembolism. Hazard ratios (HR) were estimated using Cox regression models adjusted for baseline psychiatric and physical comorbidities.

The cumulative incidence of composite CV outcomes among patients with BN (n = 11,682) was 10.0% after 10 years of follow-up. Patients with BN demonstrated a modest but significantly increased risk of composite CV outcomes (adjusted HR [aHR] 1.13 [95% CI, 1.03-1.23]), specifically those with psychiatric comorbidities (aHR 1.15 [95% CI, 1.03-1.29]) and with psychiatric hospitalization (aHR, 1.81 [95% CI, 1.25-2.61]). The risks of composite CV outcomes progressively increased across most follow-up intervals.

Patients with BN exhibited a modest but persistently elevated CV risk. CV monitoring is particularly important for BN individuals with psychiatric comorbidities and those in need of psychiatric hospitalization for timely detection and management.