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Vital Exhaustion and Coronary Heart Disease Risk: A Systematic Review and Meta-Analysis

Frestad, Daria MD; Prescott, Eva MD, DMSc

doi: 10.1097/PSY.0000000000000423
Systematic Review/Meta-Analysis

Objective The construct of vital exhaustion has been identified as a potential independent psychological risk factor for incident and recurrent coronary heart disease (CHD). Despite several decades of research, no systematic review or meta-analysis has previously attempted to collate the empirical evidence in this field. The purpose of this study was to review and quantify the impact of vital exhaustion on the development and progression of CHD.

Methods Prospective and case-control studies reporting vital exhaustion at baseline and CHD outcomes at follow-up were derived from PubMed, PsycINFO (1980 to July 2015; articles in English and published articles only), and bibliographies. Information on aim, study design, sample size, inclusion and exclusion criteria, assessment methods of psychological risk factors, and results of crude and adjusted regression analyses were abstracted independently by two authors.

Results Thirteen prospective (n = 52,636) and three case-control (cases, n = 244; controls, n = 457) studies assessed vital exhaustion and could be summarized in meta-analyses. The pooled adjusted risk of CHD in healthy populations was 1.50 (95% confidence interval [CI] = 1.22–1.85) for prospective studies, and 2.61 (95% CI = 1.66–4.10) for case-control studies using hospital controls. Risk of recurrent events in patients with CHD was 2.03 (95% CI = 1.54–2.68). The pooled adjusted risk of chronic heart failure in healthy populations was 1.37 (95% CI = 1.21–1.56), but this was based on results from only two studies.

Conclusions Vital exhaustion is associated with increased risk of incident and recurrent CHD.

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From the Department of Cardiology (Frestad, Prescott), Bispebjerg Hospital, and Department of Cardiology (Frestad), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.

Supplemental Content

Address correspondence and reprint requests to Daria Frestad, MD, Hvidovre University Hospital, Kettegård Alle 30, DK-2650 Hvidovre, Copenhagen, Denmark. E-mail:

Received for publication March 14, 2016; revision received August 12, 2016.

Copyright © 2017 by American Psychosomatic Society
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