According to new research, the eating disorder bulimia nervosa could have a link to long-term risks of cardiovascular disease. Patients may suffer cardiovascular issues such as ischemic cardiac events (severe reduction in blood flow to the heart), conduction disorders (dysfunction of the electrical system that controls heartbeat/rhythm), and even death, according to the findings published in JAMA Psychiatry.

Bulimia nervosa is one of the most common psychiatric disorders among women. According to the American Psychiatric Association, “Patients with bulimia nervosa binge eat frequently, and during these times sufferers may eat an astounding amount of food in a short time, often consuming thousands of calories. … their binges often end only when they are interrupted by another person, or they fall asleep, or their stomach hurts from being stretched beyond normal capacity. During an eating binge sufferers feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or, in serious cases, several times a day.”

Frequent purging can cause dehydration, leading to weak muscles and extreme fatigue. It can also cause excessive loss of electrolytes like sodium, magnesium and potassium, which puts a strain on the heart, causing irregular heartbeat, weakened heart muscles and even heart failure, according to Healthline.

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Researchers studied around 800 women hospitalized for bulimia nervosa and used around 40,000 women hospitalized for pregnancy-related events as a control group. Women hospitalized for bulimia nervosa had a higher incidence of cardiovascular disease compared with those hospitalized for pregnancy-related events. The incidence of cardiovascular disease was higher for women admitted three times or more for bulimia. Women hospitalized for bulimia also had around four times greater risk of cardiovascular diseases and around five times greater risk of mortality from it, in comparison to women hospitalized for pregnancy-related events.

“Bulimia nervosa was associated with most cardiovascular diseases. In adjusted models, women hospitalized for bulimia had [around 6 times] the risk of myocardial infarction, [around seven times the risk] of another ischemic heart disease, [around three times] the risk of conduction disorders, and [almost seven times] the risk of atherosclerosis compared with women hospitalized for pregnancy-related events. Risks were elevated for all other cardiovascular outcomes. Women hospitalized for bulimia also had more than [five percent] times the risk of admission to a coronary care unit,” wrote the researchers of the study.

Symptoms of bulimia involve experiencing heartburn and irregular heartbeat, which can lead to worse situations like heart attacks and plaque build up in blood vessels. This is why researchers recommend that patients struggling with bulimia nervosa seek treatment and check-ups frequently in order to keep track of their cardiovascular health.

“Our findings suggest that women with a history of bulimia nervosa should be informed of an increased risk of cardiovascular disease and death in the first decade after the index admission for bulimia. These women may benefit from screening for the prevention and treatment of cardiovascular risk factors,” the researchers wrote.