Heart Health in the Treatment of Eating Disorders

Interview with Dr. Nina Radford, M.D.

Cardiovascular Medicine Department, Cooper Clinic

Please define your credentials and role as the cardiologist for Cooper Aerobic Center at Cooper Clinic. What clinical services do you provide for patients?

I have served as a staff cardiologist at Cooper Clinic for 11 years. My credentials include:

  • Diplomat, American Board of Internal Medicine, Internal Medicine
  • Diplomat, American Board of Internal Medicine, Cardiovascular Disease
  • Specialist, American Society of Hypertension,
  • Testamur, National Board of Echocardiography
  • Diplomat, Certification Board of Nuclear Cardiology

We offer cardiovascular consultations, resting and stress echocardiography, resting EKG, treadmill exercise stress testing and coronary CT angiography.

As you probably know, February is heart health month and why do you think this is important to acknowledge this?

February is Heart Health Month. I think it is important to acknowledge this to remind people of two important things. First, heart disease is a common cause of death in the United States. Second, and more importantly, we have a great deal of control as individuals over whether we develop heart disease based on the lifestyle choices we make.
According to the American Heart Association 2013 Statistical Update, coronary heart disease alone caused ≈1 of every 6 deaths in the United States in 2009. In 2009, 386,324 Americans died of coronary heart disease. Each year, an estimated ≈635,000 Americans have a new coronary attack (defined as first hospitalized heart attack or coronary heart disease death) and ≈280 000 have a recurrent attack. Approximately every 34 seconds, 1 American has a coronary event, and approximately every 1 minute, an American will die of one.
Despite the fact that we know we should not smoke cigarettes, among Americans ≥18 years of age, 21.3% of men and 16.7% of women continued to be cigarette smokers. In 2011, 18.1% of students in grades 9 through 12 reported current cigarette use.
Despite the fact that we know physical activity is good for us, 32% of adults reported engaging in no aerobic leisure-time physical activity.
I think February is the perfect time to reexamine those New Year’s resolutions that are focused on health and refocus our efforts in changing those lifestyle habits that are unhealthy!

It appears heart disease is on the rise for women in particular and can you please report the most current research and the reasons why it has become so problematic for the female gender?

Actually, deaths for cardiovascular disease are going down in both men and women. Women are lagging behind for a number of reasons. Historically, women have been treated less aggressively than men but this is changing. Many women now are treated with all the lifesaving therapies that are available to men. Women tend to be about ten years older than men when they develop heart disease at which time they many have multiple other health problems. This is why prevention of heart disease is so very important in women.

Please describe why you think it is important for patients from The Walker Wellness Clinic who are suffering from a formal eating disorder to seek out a cardiac assessment?

Patients with eating disorders can develop a number of cardiac complications including low heart rate (bradycardia), low blood pressure (hypotension), abnormalities of heart valve function (mitral valve prolapse), fluid collection around the heart (pericardial effusion), heart rhythm abnormalities (extra, rapid or irregular heart beats), depression heart muscle function and changes on the resting EKG (QTc prolongation, first degree heart block, ST-T wave abnormalities).

Can you give one specifics on what the cardiac assessment includes and what the findings may reveal with the test results?

The cardiac assessment begins with a thorough history, cardiovascular examination and resting EKG. Depending on what signs or symptoms are discovered, a resting echocardiogram may be performed to look for valve disorders, heart muscle dysfunction or fluid around the heart.

What recent empirical research can you give us in regards to treating eating disorders and cardiac complications?

It appears that many of the cardiac changes seen in patients with anorexia are reversible. In one recent study of 173 adolescents diagnosed with anorexia nervosa, who were hospitalized, had echocardiograms before and after treatment which were compared to echocardiograms of healthy adolescents of the same age. Thirty-seven percent of the anorexia patients had fluid around the heart (pericardial effusion). The pericardial effusion resolved in 88% of these patients after weight restoration (Kastner et al., Eur Child Adolesc Psychiatry. 2012;21(1):15-21.)
The treatment of eating disorders is incremental caloric feeding, which can have its own intrinsic cardiovascular risk (refeeding syndrome) manifested by arrhythmia, tachycardia, congestive heart failure, and sudden cardiac death. This is a more common occurrence in an in-patient setting.

Can a patient recover from cardiac issues if they are able to restore their normal weight range and normalize their eating? If so, how does this happen?

This likely occurs because of restoration of normal electrolyte balance (salts in the blood), normal fluid balance in the heart and normalization of levels of various hormones which become disordered under the stress of malnutrition.

What does the future research show for the role that cardiologists will play in the treatment of eating disorders?

Cardiologists will likely remain an important consultant on the medical team treating eating disorders. This will be particularly true as the patient with anorexia ages into midlife and issues regarding the development of atherosclerosis (hardening of the arteries) come into play.
As part of our comprehensive treatment program at Walker Wellness Clinic, we collaborate with highly competent cardiologists, physicians, and OBGYN’s to ensure the medical stability of each one of our patients. We continue to communicate with the team of medical professionals throughout the treatment process in order to monitor the physical health of the patients we serve.