Tseng Mei-Chih Meg, Chiou Kuan-Rau, Shao Joni Yu-Hsuan, Liu Hung-Yi
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
JAMA Netw Open. 2024 Dec 2;7(12):e2451094. doi: 10.1001/jamanetworkopen.2024.51094.
Anorexia nervosa (AN) is commonly associated with cardiovascular complications.
To investigate the trajectories of the risk of cardiovascular conditions in a nationwide cohort of patients with AN in Taiwan.
DESIGN, SETTING, AND PARTICIPANTS: From a population-based health insurance database from January 1, 2011, to December 31, 2021, this longitudinal cohort study identified patients with AN and controls through propensity score matching at a 1:10 ratio according to sex, age, urbanization level of residence, socioeconomic status, and year of diagnosis. Data were analyzed from June 27, 2023, to February 23, 2024.
First-time diagnosis of AN by psychiatrists during the study period.
Incidence and risk of composite cardiovascular conditions. Kaplan-Meier curves were used to estimate the cumulative incidence of major adverse cardiovascular events (MACE) and any cardiovascular condition. With adjustment for psychiatric comorbidities, conditional Cox proportional hazards regression analyses were performed to estimate the risk of cardiovascular events, which were presented as hazard ratios (HRs) and 95% CIs, relative to the comparison group. Risks of individual cardiovascular conditions were calculated during 3 follow-up periods after AN diagnosis.
The study population included 2081 patients with AN and 20 810 matched controls, for a total of 22 891 participants (mean [SD] age, 24.9 [9.9] years; 91.3% female). In total, 99 patients with AN (4.8%) had MACE vs 175 (0.8%) in controls, and 124 patients with AN (6.0%) had any cardiovascular condition vs 483 controls (2.3%). At the 5-year follow-up, the cumulative incidence rate of MACE was 4.82% (95% CI, 3.85%-6.02%) and of any cardiovascular condition was 6.19% (95% CI, 5.19%-7.53%). Compared with the control group, the AN group had significantly higher risks of MACE (adjusted HR [AHR], 3.78; 95% CI, 2.83-5.05) and any cardiovascular condition (AHR, 1.93; 95% CI, 1.54-2.41). The significantly increased risks of congestive heart failure, conduction disorder, and structural heart disease occurred in the initial follow-up period and disappeared after 60 months of follow-up. Notably, patients with AN did not have an increased risk of ischemic heart disease until after 60 months of follow-up (AHR, 3.01; 95% CI, 1.48-6.13).
In this national matched cohort study, increased risk of cardiovascular conditions was found in different periods after AN diagnosis. Clinicians should monitor comorbid cardiovascular conditions among patients with AN at initial presentation, during treatment, and at follow-up.
神经性厌食症（AN）通常与心血管并发症相关。
调查台湾全国范围内AN患者队列中心血管疾病风险的变化轨迹。
设计、设置和参与者：本纵向队列研究从2011年1月1日至2021年12月31日基于人群的健康保险数据库中，根据性别、年龄、居住城市化水平、社会经济地位和诊断年份，通过倾向得分匹配以1:10的比例确定AN患者和对照组。数据于2023年6月27日至2024年2月23日进行分析。
研究期间精神科医生首次诊断为AN。
复合心血管疾病的发病率和风险。采用Kaplan-Meier曲线估计主要不良心血管事件（MACE）和任何心血管疾病的累积发病率。在调整精神科合并症后，进行条件Cox比例风险回归分析以估计心血管事件的风险，结果以风险比（HR）和95%置信区间表示，相对于对照组。在AN诊断后的3个随访期内计算个体心血管疾病的风险。
研究人群包括2081例AN患者和20810例匹配的对照组，共22891名参与者（平均[标准差]年龄，24.9[9.9]岁；91.3%为女性）。总共99例AN患者（4.8%）发生MACE，而对照组为175例（0.8%），124例AN患者（6.0%）患有任何心血管疾病，对照组为483例（2.3%）。在5年随访时，MACE的累积发病率为4.82%（95%置信区间，3.85%-6.02%），任何心血管疾病的累积发病率为6.19%（95%置信区间，5.19%-7.53%）。与对照组相比，AN组发生MACE（调整后HR[AHR]，3.78；95%置信区间，2.83-5.05）和任何心血管疾病（AHR，1.93；95%置信区间，1.54-2.41）的风险显著更高。充血性心力衰竭、传导障碍和结构性心脏病的风险在初始随访期显著增加，并在随访满60个月后消失。值得注意的是，AN患者直到随访满60个月后缺血性心脏病风险才增加（AHR，3.01；95%置信区间，1.48-6.13）。
在这项全国性匹配队列研究中，发现AN诊断后的不同时期心血管疾病风险增加。临床医生应在AN患者初次就诊、治疗期间和随访时监测合并的心血管疾病。
