Exhaustion predicts coronary heart disease independently of symptoms of depression and anxiety in men but not in women.
OBJECTIVE
Exhaustion is hypothesised to be a risk-factor for coronary heart disease (CHD), but as such its independence from emotional states, in particular depression, has not been established in previous investigations. This study aimed to explore the unique contribution of exhaustion, independent from symptoms of depression and anxiety, to CHD development.


METHODS
The study sample was 5061 men and 6734 women from the Malmö Shoulder and Neck Study cohort examined in 1993-96. Exhaustion was measured by the SF-36 vitality scale. Symptoms of depression and anxiety were measured by the General Health Questionnaire. 571 first coronary events were ascertained through record linkage until 2005. Cox regression analysis was used to assess the contribution of exhaustion to CHD.


RESULTS
In age-adjusted analysis exhaustion predicted coronary events in a non-linear way in both men (HR=1.49, 95% CI 1.06-2.11 in the highest exhaustion category) and women (HR=1.78, 95% CI 1.23-2.58 in the second highest exhaustion category). After adjustment for traditional risk-factors for CHD and socioeconomic status, the effect was attenuated and statistically significant only in women. However, further adjustment for symptoms of depression and anxiety strengthened the association between exhaustion and CHD in men (HR=1.62, 95% CI 1.05-2.50), whereas in women, exhaustion no longer predicted CHD.


CONCLUSIONS
In age-adjusted analysis, exhaustion predicted CHD in both men and women, but its independence from depression and anxiety was demonstrated only in men. Further studies on the topic are required. A larger focus on potential gender differences should seem warranted in future research.
Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Sweden. sara.lindeberg@med.lu.se
Sara I
SI
Lindeberg
Maria
M
Rosvall
Per-Olof
PO
Östergren
D000368:Aged; D001007:Anxiety / Q000175:diagnosis*; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis*; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors