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Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women.
JAMA Psychiatry ( IF 25.8 ) Pub Date : 2019-10-16 , DOI: 10.1001/jamapsychiatry.2019.2914
Rasmi M Tith 1, 2 , Gilles Paradis 2, 3 , Brian J Potter 4, 5 , Nancy Low 6 , Jessica Healy-Profitós 2, 4 , Siyi He 2, 4 , Nathalie Auger 2, 3, 4, 7
Affiliation  

Importance Bulimia nervosa is associated with short-term cardiovascular complications in women, but its long-term consequences on cardiovascular health are unknown. Objective To study the association of bulimia nervosa with the long-term risk of cardiovascular disease and mortality in women. Design, Setting, and Participants In this longitudinal cohort study, 416 709 women hospitalized in Quebec, Canada, including women hospitalized for bulimia nervosa and those for pregnancy-related events as a comparison group, were followed up for 12 years from 2006 to 2018 to identify incidences of cardiovascular disease and death. Exposures At least 1 hospitalization for bulimia nervosa. Main Outcomes and Measures The study participants were followed up to identify future incidences of cardiovascular disease and deaths. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs to assess the association of bulimia nervosa with future outcomes after adjustment for patient characteristics. Results The study population comprised 818 women who were hospitalized for bulimia nervosa (mean [SD] age, 28.3 [13.4] years) and 415 891 hospitalized for pregnancy-related events (mean [SD] age, 28.3 [5.4] years). Patients were followed up for a total of 2 957 677 person-years. The women hospitalized for bulimia nervosa had a greater incidence of cardiovascular disease compared with those hospitalized for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs 1.02 [95% CI, 0.99-1.06] per 1000 person-years). Incidence of future cardiovascular disease was even higher for women with 3 or more bulimia admissions (25.13 [95% CI, 13.52-46.70] per 1000 person-years). Women hospitalized for bulimia nervosa had 4.25 (95% CI, 2.98-6.07) times the risk of any cardiovascular disease and 4.72 (95% CI, 2.05-10.84) times the risk of death compared with women hospitalized for pregnancy-related events. Bulimia nervosa was found to be associated with ischemic heart disease (HR, 6.63; 95% CI, 3.34-13.13), atherosclerosis (HR, 6.94; 95% CI, 3.08-15.66), and cardiac conduction defects (HR, 2.99; 95% CI, 1.57-5.71). Bulimia was also associated with 21.93 (95% CI, 9.29-51.74) times the risk of myocardial infarction at 2 years of follow-up and 14.13 (95% CI, 6.02-33.18) times the risk at 5 years of follow-up. Conclusions and Relevance This study's findings suggest that bulimia nervosa may be associated with the long-term risk of any cardiovascular disease, such as ischemic cardiac events and conduction disorders, as well as with death among women. The findings also suggest that women with a history of bulimia nervosa should be screened regularly for ischemic cardiovascular disease and may benefit from prevention of and treatment for cardiovascular risk factors.

中文翻译:

神经性贪食症与妇女心血管疾病和死亡率的长期风险相关。

重要性神经性贪食症与女性的短期心血管并发症有关,但其对心血管健康的长期影响尚不清楚。目的研究神经性贪食症与妇女长期罹患心血管疾病和死亡的关系。设计,背景和参与者在这项纵向队列研究中,从2006年至2018年,对在加拿大魁北克住院的416709名妇女(包括因神经性贪食症和与妊娠相关事件而住院的妇女)进行了比较,随访了12年。确定心血管疾病和死亡的发生率。暴露至少有1例因神经性贪食症而住院。主要结果和措施对研究参与者进行随访,以查明心血管疾病和死亡的未来发生率。使用Cox比例风险回归来估计风险比(HR)和95%CI,以评估针对患者特征进行调整后的神经性贪食症与未来结局的关联。结果研究人群包括818例因神经性贪食症住院的妇女(平均[SD]年龄,28.3 [13.4]岁)和415 891例因妊娠相关事件住院的妇女(平均[SD]年龄,28.3 [5.4]岁)。对患者进行了总共2 957 677人年的随访。与因妊娠相关事件住院的妇女相比,因神经性贪食症住院的妇女发生心血管疾病的几率更高(每千人年10.34 [95%CI,7.77-13.76] vs 1.02 [95%CI,0.99-1.06]) 。对于患有3次或以上暴食症的女性,未来心血管疾病的发生率甚至更高(25.13 [95%CI,13.52-46。70](每1000人年)。与因妊娠相关事件住院的妇女相比,因神经性贪食症住院的妇女发生心血管疾病的风险是其死亡率的4.25倍(95%CI,2.98-6.07)倍,而死亡的风险是其死亡风险的4.72倍(95%CI,2.05-10.84)倍。发现神经性贪食症与缺血性心脏病(HR,6.63; 95%CI,3.34-13.13),动脉粥样硬化(HR,6.94; 95%CI,3.08-15.66)和心脏传导缺陷(HR,2.99; 95)相关%CI,1.57-5.71)。随访2年,贪食症的发生率是心肌梗塞风险的21.93(95%CI,9.29-51.74)倍,而随访5年则发生心肌梗塞的风险是14.13(95%CI,6.02-33.18)倍。结论与相关性这项研究的发现表明,神经性贪食症可能与任何心血管疾病的长期风险有关,例如缺血性心脏事件和传导障碍,以及女性死亡。研究结果还表明,应定期筛查有神经性贪食症史的妇女是否患有缺血性心血管疾病,并应从预防和治疗心血管危险因素中受益。
更新日期:2020-01-02
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