title: Vital Exhaustion and Coronary Heart Disease Risk: A Systematic Review and Meta-Analysis.
abstract: 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.
authors.affiliation: From the Department of Cardiology (Frestad, Prescott), Bispebjerg Hospital, and Department of Cardiology (Frestad), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Daria
authors.initials: D
authors.lastname: Frestad
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D005221:Fatigue / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007508:Irritable Mood / Q000502:physiology*; D009013:Morale