IM - REVIEW Cardiovascular disorders in anorexia nervosa and potential therapeutic targets Giovanni Di Cola • Francesca Jacoangeli • Fabrizio Jacoangeli • Mauro Lombardo • Ferdinando Iellamo Received: 24 May 2014 / Accepted: 5 July 2014 / Published online: 24 July 2014 Ó SIMI 2014 Abstract Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restric- tions in eating habits. AN may be divided into two types: a ‘‘binge-eating/purging type’’ during which the individual regularly engages in overeating and then purging behavior, and a ‘‘restricting type’’, in which she does not. AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN exhibit an enhanced mortality rate as compared with age-matched healthy subjects, which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Cardiovascular complications of AN can be present in up to 80 % of cases, and among them alterations in cardiac electrical activity, structure and hemodynamics have been reported as causes of morbidity and mortality. The objective of this brief review is to summarize current knowledge on the main cardiovascular complications of AN, their underlying mechanisms and the possible therapeutic approaches. Keywords Anorexia nervosa Á Cardiac complication Á Mechanisms Á Clinical management Introduction Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in eating habits. Diagnostic criteria for AN include: (1) refusal to maintain body weight at or above a minimally normal weight for age and height; (2) intense fear of gaining weight or becoming fat, even though being under weight; (3) disturbance in the way one’s body weight or shape are experienced, and (4) amenorrhea (at least three consecutive cycles) in postmenarchal girls and women [1]. Always according to DSM-IV-TR [1] AN may be divided into two types: a ‘‘binge-eating/purging type’’ during which the individual regularly engages in overeating and then purging behavior, and a ‘‘restricting type’’, in which she does not (Table 1). AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN feature an enhanced mortality rate as compared with age-matched healthy subjects [2, 3], which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death [3]. Cardio- vascular complications of AN can be present in up to 80 % of cases [4] and among them alterations in cardiac elec- trical activity, structure and hemodynamics have been G. Di Cola Á F. Iellamo (&) Dipartimento di Medicina dei Sistemi, Universita ` di Roma Tor Vergata, Via O. Raimondo, 8, 00173 Rome, Italy e-mail: iellamo@med.uniroma2.it F. Jacoangeli Unita ` di Cardiologia Osp. S. Andrea, II Facolta ` di Medicina, Universita ` di Roma La Sapienza, Rome, Italy F. Jacoangeli Dipartimento di Biomedicina, Universita ` di Roma Tor Vergata, Rome, Italy M. Lombardo Universita ` Telematica San Raffaele, Rome, Italy F. Iellamo Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy 123 Intern Emerg Med (2014) 9:717–721 DOI 10.1007/s11739-014-1107-2