In the Journals

Vital exhaustion may increase AF risk

Parveen K. Garg

Patients who reported vital exhaustion on a questionnaire had an increased risk for incident atrial fibrillation, according to a study published in the European Journal of Preventive Cardiology.

“It is already known that exhaustion can be harmful for one’s mental health, but our findings suggest that it may also adversely affect one’s heart health as well,”

Parveen K. Garg, MD, assistant professor of clinical medicine at University of Southern California Keck School of Medicine, told Healio. “Exhaustion increases one’s risk for cardiovascular disease including heart attack and stroke, and also now, based on our results, for AF, a potentially serious cardiac arrhythmia. Managing exhaustion may be important to preserve both mind and heart health.”

Atherosclerosis Risk in Communities data

Researchers analyzed data from 11,445 patients (mean age, 57 years; 56% women) from the Atherosclerosis Risk in Communities study who were free from AF at baseline between 1990 and 1992. Several psychosocial measures were assessed including anger, vital exhaustion, antidepressant use and social ties. The primary outcome was defined as incident AF throughout 2016.

During a median of 23.4 years of follow-up, 19.4% developed AF with an incidence rate of 9.8 per 1,000 person-years (95% CI, 9.5-10.2).

An increased risk for AF was observed in patients in the fourth quartile of the Vital Exhaustion Questionnaire (HR = 1.45; 95% CI, 1.29-1.64) and in those who reported antidepressant use (HR = 1.37; 95% CI, 1.11-1.69) compared with those in the first quartile for the questionnaire after adjusting for sex, age, race/center, education and height. The relationship between the fourth quartile of the Vital Exhaustion Questionnaire and an increased risk for AF remained significant after adjusting further for relevant comorbidities including weight, diabetes, cigarette smoking, systolic and diastolic BP, and physical activity (HR = 1.2; 95% CI, 1.06-1.35).

Baseline measures of social support, anger or social network were not significantly associated with the development of AF.

“Although we found evidence that higher levels of exhaustion may lead to an increased risk of atrial fibrillation, further studies need to be done before we can translate this into something that is meaningful clinically or actionable on the part of physicians,” Garg said in an interview.

Vital exhaustion vs. depression

Rolf Wachter

In a related editorial, Christoph Herrmann-Lingen, MD, clinic director in the department of psychosomatic medicine and psychotherapy at the University of Göttingen Medical Center in Germany, and Rolf Wachter, MD, associate professor at the Clinic and Polyclinic for Cardiology at University Hospital Leipzig in Germany, wrote: “Vital exhaustion is not completely the same as depression. It shows more overlap with sickness behavior typically found in situations of hypocortisolism and inflammation, while typical depression has been associated with hypercortisolemia. Rather than being a risk factor in itself, vital exhaustion may therefore just reflect a proinflammatory state that can predispose to AF. As markers of inflammation were not controlled in the current paper, this possibility cannot be ruled out.” – by Darlene Dobkowski

For more information:

Parveen K. Garg, MD, can be reached at Division of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St., Suite 322, Los Angeles, CA 90033; email: parveeng@med.usc.edu.

Disclosures: The authors of the study and the editorial report no relevant financial disclosures.

Parveen K. Garg

Patients who reported vital exhaustion on a questionnaire had an increased risk for incident atrial fibrillation, according to a study published in the European Journal of Preventive Cardiology.

“It is already known that exhaustion can be harmful for one’s mental health, but our findings suggest that it may also adversely affect one’s heart health as well,”

Parveen K. Garg, MD, assistant professor of clinical medicine at University of Southern California Keck School of Medicine, told Healio. “Exhaustion increases one’s risk for cardiovascular disease including heart attack and stroke, and also now, based on our results, for AF, a potentially serious cardiac arrhythmia. Managing exhaustion may be important to preserve both mind and heart health.”

Atherosclerosis Risk in Communities data

Researchers analyzed data from 11,445 patients (mean age, 57 years; 56% women) from the Atherosclerosis Risk in Communities study who were free from AF at baseline between 1990 and 1992. Several psychosocial measures were assessed including anger, vital exhaustion, antidepressant use and social ties. The primary outcome was defined as incident AF throughout 2016.

During a median of 23.4 years of follow-up, 19.4% developed AF with an incidence rate of 9.8 per 1,000 person-years (95% CI, 9.5-10.2).

An increased risk for AF was observed in patients in the fourth quartile of the Vital Exhaustion Questionnaire (HR = 1.45; 95% CI, 1.29-1.64) and in those who reported antidepressant use (HR = 1.37; 95% CI, 1.11-1.69) compared with those in the first quartile for the questionnaire after adjusting for sex, age, race/center, education and height. The relationship between the fourth quartile of the Vital Exhaustion Questionnaire and an increased risk for AF remained significant after adjusting further for relevant comorbidities including weight, diabetes, cigarette smoking, systolic and diastolic BP, and physical activity (HR = 1.2; 95% CI, 1.06-1.35).

Baseline measures of social support, anger or social network were not significantly associated with the development of AF.

“Although we found evidence that higher levels of exhaustion may lead to an increased risk of atrial fibrillation, further studies need to be done before we can translate this into something that is meaningful clinically or actionable on the part of physicians,” Garg said in an interview.

Vital exhaustion vs. depression

Rolf Wachter

In a related editorial, Christoph Herrmann-Lingen, MD, clinic director in the department of psychosomatic medicine and psychotherapy at the University of Göttingen Medical Center in Germany, and Rolf Wachter, MD, associate professor at the Clinic and Polyclinic for Cardiology at University Hospital Leipzig in Germany, wrote: “Vital exhaustion is not completely the same as depression. It shows more overlap with sickness behavior typically found in situations of hypocortisolism and inflammation, while typical depression has been associated with hypercortisolemia. Rather than being a risk factor in itself, vital exhaustion may therefore just reflect a proinflammatory state that can predispose to AF. As markers of inflammation were not controlled in the current paper, this possibility cannot be ruled out.” – by Darlene Dobkowski

For more information:

Parveen K. Garg, MD, can be reached at Division of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St., Suite 322, Los Angeles, CA 90033; email: parveeng@med.usc.edu.

Disclosures: The authors of the study and the editorial report no relevant financial disclosures.