Abstract MP40: Vital Exhaustion as a Predictor of Recurrent Cardiac Events in Patients with Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Several studies have demonstrated a positive relationship between vital exhaustion and incident coronary heart disease (CHD), but the association of exhaustion with recurrent cardiac events has not been established in large, epidemiologic studies. Vital exhaustion is considered the end-stage of prolonged psychological distress and is characterized by excessive fatigue, increased irritability, and a sense of demoralization. We assessed the hypothesis that vital exhaustion predicts recurrent cardiac events (myocardial infarction and CHD-related mortality) among middle-aged men and women with documented CHD. Participants were 589 black or white men and women (mean age = 59.8; range = 47 - 69 years) with a history of CHD at the 1990-1992 clinical examination of the ARIC Study. Vital exhaustion was measured at the same ARIC examination using the 21-item Maastricht Questionnaire, and scores were categorized into quartiles. Recurrent cardiac events were monitored in short term (0-5 years), mid- term (6-13 years), and long-term (14-19 years) follow-up. Cox proportional hazards regression models were adjusted for age, sex, race-center, educational level, body mass index, plasma LDL-and HDL-cholesterol levels, hypertension status, and pack-years of cigarette smoking. During short term follow-up, the risk for recurrent cardiac events among participants in the highest quartile of vital exhaustion was twice that of participants in the remainder of the sample (HR = 2.08; 95% C.I: 1.24 to 3.48). The risk was less strong but remained statistically significant in mid-term (HR = 1.77; 95% C.I: 1.26 to 2.48) and long-term (HR = 1.54; 95% C.I: 1.12 to 2.11) follow-up. In conclusion, vital exhaustion is positively associated with short-term and long-term risks for recurrent cardiac events among middle-aged men and women with established coronary heart disease, independent of the traditional biomedical risk factors.