Most Read Articles
Roshini Claire Anthony, 23 Nov 2017

The long-term mortality benefit conferred by mechanical over biologic prosthesis in valve replacement appears to be age- and location-dependent, according to findings of a US-based retrospective study.  

10 Jan 2018
Shared decision support with the use of standardized decision aids improves decision quality and reduces implantation of left ventricular assist device as destination therapy (DT-LVAD) in patients with advanced heart failure.
Pearl Toh, 6 days ago
The protective effects of liraglutide against the risks of cardiovascular (CV) events and deaths may be reduced in patients with type 2 diabetes (T2D) who experienced severe hypoglycaemia, but were independent of patient’s history of CV events at baseline, according to post hoc analyses of the LEADER* trial.
01 Aug 2015
A higher prevalence of coronary artery disease was reported among adult men than women with Kawasaki disease, a study shows.

Vital exhaustion not a risk factor for sudden cardiac death

Jairia Dela Cruz
29 Sep 2017

Vital exhaustion (VE)—defined as lack of energy, increased fatigue and irritability, and feelings of demoralization—does not contribute to an increased risk of sudden cardiac death (SCD), according to a US study.

The present investigation used data from a biracial (black and white) cohort of 13,923 individuals aged 45 to 64 years at baseline from the ARIC (Atherosclerosis Risk in Communities) study. VE, measured using the Maastricht questionnaire, was low among 4,464, moderate among 4,869 and high among 4,590 participants. Those with high VE were particularly older and more likely to exhibit cardiovascular disease risk factors. [Heart 2017;doi:10.1136/heartjnl-2017-311825]

A total of 457 SCD events occurred during a median follow-up of 21.2 years, with the incidence rate higher in the high vs low and moderate VE groups (1.98 vs 1.45 and 1.47 per 1,000 person-years).

The highest VE tertile was associated with a 48-percent increase in the risk of SCD (hazard ratio [HR], 1.48; 95 percent CI, 1.17 to 1.87; p=0.001) in a Cox proportional hazards model controlling for age, sex and race/centre. However, this association disappeared after adjustment for established cardiovascular disease risk factors (HR, 0.94; 0.73 to 1.20; p=0.609). Results were robust to various definitions of SCD.

SCD was defined as follows: 1) a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual without evidence of a noncardiac cause (eg, drug overdose, stroke, aortic aneurysm rupture, other acute bleeding, pulmonary embolism, acute respiratory failure or trauma); 2) fatal coronary heart disease (CHD) within 1 hour of symptom onset; and 3) fatal CHD within 24 hours of symptom onset.

Contrary to previous reports of an association between VE and various cardiovascular disease endpoints, including the ARIC study, the present data do not show an association between VE and SCD over either short- or long-term follow-up on adjustment, the investigators pointed out. [Ann Epidemiol 2004;14:416–24; Am J Cardiol 2010;105:1661–5; Eur Heart J 2015;36:1385–93]

“While it is possible that our differing conclusions may be attributable to the outcome definition, our conclusions were predominately consistent for several SCD endpoints,” they said, while acknowledging the difficulty of ascertaining SCD and the absence of a uniform agreement on how to operationally define SCD.

“[B]ased on our findings, it may be more accurate to view VE as possible precursor to more prevalent cardiovascular disease events than as a predictor specific to SCD,” the investigators said.

More studies are warranted to further examine the relation of psychosocial stressors with SCD, they added.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 23 Nov 2017

The long-term mortality benefit conferred by mechanical over biologic prosthesis in valve replacement appears to be age- and location-dependent, according to findings of a US-based retrospective study.  

10 Jan 2018
Shared decision support with the use of standardized decision aids improves decision quality and reduces implantation of left ventricular assist device as destination therapy (DT-LVAD) in patients with advanced heart failure.
Pearl Toh, 6 days ago
The protective effects of liraglutide against the risks of cardiovascular (CV) events and deaths may be reduced in patients with type 2 diabetes (T2D) who experienced severe hypoglycaemia, but were independent of patient’s history of CV events at baseline, according to post hoc analyses of the LEADER* trial.
01 Aug 2015
A higher prevalence of coronary artery disease was reported among adult men than women with Kawasaki disease, a study shows.