title: Meta-Analysis of Relation of Vital Exhaustion to Cardiovascular Disease Events.
abstract: To assess the net impact of vital exhaustion on cardiovascular events and all-cause mortality, we conducted a systematic search of PubMed, EMBASE, and PsychINFO (through April 2016) to identify all studies which investigated the relation between vital exhaustion (VE) and health outcomes. Inclusion criteria were as follows: (1) a cohort study (prospective cohort or historical cohort) consisting of adults (>18 years); (2) at least 1 self-reported or interview-based assessment of VE or exhaustion; (3) evaluated the association between vital exhaustion or exhaustion and relevant outcomes; and (4) reported adjusted risk estimates of vital exhaustion/exhaustion for outcomes. Maximally adjusted effect estimates with 95% CIs along with variables used for adjustment in multivariate analysis were also abstracted. Primary study outcome was cardiovascular events. Secondary outcomes were stroke and all-cause mortality. Seventeen studies (19 comparisons) with a total of 107,175 participants were included in the analysis. Mean follow-up was 6 years. VE was significantly associated with an increased risk for cardiovascular events (relative risk 1.53, 95% CI 1.28 to 1.83, p <0.001) and all-cause mortality (relative risk 1.48, 95% CI 1.28 to 1.72, p <0.001). VE also showed a trend for increased incident stroke (relative risk 1.46, 95% CI 0.97 to 2.21, p = 0.07). Subgroup analyses yielded similar results. VE is a significant risk factor for cardiovascular events, comparable in potency to common psychosocial risk factors. Our results imply a need to more closely study VE, and potentially related states of exhaustion, such as occupational burnout.
authors.affiliation: Crystal Run Healthcare, Cardiology Division, West Nyack, New York. Electronic address: racohen@crystalrunhealthcare.com.
authors.forename: Randy
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Department of Medicine, Mount Sinai St. Luke's Hospital Center, Mount Sinai Heart and the Icahn School of Medicine, New York, New York; Division of Cardiology, Mount Sinai St. Luke's Hospital Center, Mount Sinai Heart and the Icahn School of Medicine, New York, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: Department of Medicine, Mount Sinai St. Luke's Hospital Center, Mount Sinai Heart and the Icahn School of Medicine, New York, New York.
authors.forename: Syed
authors.initials: S
authors.lastname: Haider
authors.affiliation: Division of Cardiology, Stony Brook University Hospital, Stony Brook, New York.
authors.forename: Jincy
authors.initials: J
authors.lastname: Thankachen
authors.affiliation: Department of Medicine, Mount Sinai St. Luke's Hospital Center, Mount Sinai Heart and the Icahn School of Medicine, New York, New York; Division of Cardiology, Mount Sinai St. Luke's Hospital Center, Mount Sinai Heart and the Icahn School of Medicine, New York, New York.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D005221:Fatigue / Q000150:complications*; D006801:Humans; D007508:Irritable Mood; D012307:Risk Factors; D020521:Stroke / Q000209:etiology