title: Vasovagal syncope related to emotional stress predicts coronary events in later life.
abstract: BACKGROUND
  The aim of the study was to assess whether history of vasovagal syncope (VVS) mediated by emotional (emotional VVS) or orthostatic stress (orthostatic VVS) is associated with an increased risk of cardiovascular (CV) events in later life.
  
  
  METHODS
  Retrospective analysis based on medical records of the consecutive 3,288 cardiologic outpatients (mean age, 61 ± 12 years; 43% men).
  
  
  RESULTS
  A total of 254 patients (7.7%) reported emotional VVS, whereas 294 (9.0%) had history of orthostatic VVS. First-ever syncopal episode was reported at a median age of 16 years (interquartile range [IQR], 12 years to 28 years), and the median total number of episodes was two (IQR, 1 to 5). There were 779 patients (23.7%) with at least one CV event, and the median age for the first CV event was 59 years (IQR, 52 years to 67 years). In the fully adjusted model, history of emotional VVS was predictive of CV event (hazard ratio [95% confidence interval]: 1.63, [1.27-2.09]; P < 0.001), myocardial infarction (1.99, [1.49-2.66]; P < 0.001), and percutaneous coronary intervention (1.84, [1.31-2.60]; P = 0.001). There was one significant interaction (P = 0.07) between history of emotional VVS and gender. Emotional VVS was predictive of CV event in men (1.89 [1.41-2.53]; P < 0.001) but not in women (1.24 [0.79-1.94]; P = 0.35).
  
  
  CONCLUSIONS
  History of emotional but not orthostatic VVS is independently associated with increased risk of coronary events in later life. The relationship between predisposition to emotional VVS in adolescence and development of cardiovascular disease requires further studies.
authors.affiliation: Department of Emergency Medicine, Wrocław Medical University, Wrocław, Poland. dzysko@wp.pl
authors.forename: Dorota
authors.initials: D
authors.lastname: Zysko
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
authors.forename: Artur
authors.initials: A
authors.lastname: Fedorowski
mesh_terms: D017677:Age Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013315:Stress, Psychological / Q000175:diagnosis / Q000401:mortality*; D016019:Survival Analysis; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000401:mortality*
keywords: autonomic nervous system; cardiovascular disease; myocardial infarction; psychological stress; vasovagal syncope