Abstract
Anorexia nervosa (AN) is associated with cardiovascular complications and abnormalities of biomarkers associated with cardiovascular risk. Arterial stiffness, which is a risk factor for cardiovascular disease, has not been previously studied in patients with AN. This study aimed to determine the biophysical properties of the aorta in adolescent females with AN as compared to control subjects using Doppler echocardiography. This was a retrospective case-control study. Aortic diameter and pulse wave transit time were measured with echo-Doppler. Blood pressure was recorded at the time of the echocardiogram. Pulse wave velocity (PWV), aortic input impedance (Zi), characteristic impedance (Zc), arterial pressure-strain elastic modulus (Ep), and arterial wall stiffness index (β-index) were calculated. Patients were divided into those with BMI ≤ or > 10th percentile to assess the effect of patient malnutrition on the biophysical properties of the aorta. There were 94 adolescent females with AN and 60 adolescent female controls. There was no difference in age between AN patients and controls (15.5±1.7 vs 15.1±2.6 years, p=0.220). BMI (16.0±2.4vs 19.7 ± 2.7, p<0.001) and BMI percentile (9.4±15.6.vs 45.5 ± 26.2, p<0.001) were significantly lower for AN patients than for controls. PWV (443±106 vs 383±77cm/s, p<0.001), Zc (179±55 vs 149±37, p<0.001), and β-index (3.07±1.09 vs 2.66±0.75, p=0.013) were significantly higher in AN patients than controls. There was no significant difference in Zi (198±53 vs 197±36, p=0.869) while Ep was decreased (232±84 vs 267±79, p=0.014) in AN patients compared to controls. PWV remained elevated compared to controls when AN patients were divided into those with BMI ≤ or > 10th percentile. Using multiple linear regression, the only independent predictor of PWV was the presence of AN. The increased PWV, which is the most sensitive indicator of vascular dysfunction, indicates increased aortic stiffness in adolescent females with AN compared to controls. Increased PWV was not related to the degree of patient malnutrition. Our study suggests that patients with AN may be at increased risk of future cardiovascular disease. Further studies are required to determine if these changes persist with treatment and to determine long term outcomes.
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