Understanding the Link Between Vital Exhaustion and Heart Health

We know that stress is considered a risk factor for cardiovascular disease, but how exactly are the two connected? Researchers at Baylor College of Medicine looked at vital exhaustion as a measure of chronic stress and found that higher levels of vital exhaustion increase certain blood biomarkers that are associated with cardiovascular disease, showing a potential connection between the two. The findings appear in the Journal of the American College of Cardiology Advances. 

What is vital exhaustion?

Vital exhaustion, which may manifest as a combination of symptoms such as extreme fatigue, feelings of hopelessness and irritability, does not automatically indicate a clinical diagnosis of depression or anxiety but has been associated with heart disease.

To assess vital exhaustion, researchers used the Maastricht Vital Exhaustion Questionnaire (MVEQ), which comprises a set of questions designed to gauge an individual's state of exhaustion. Some questions include: Do you feel more listless than before? Do you have feelings of hopelessness? Do you feel weak all over? Do you wake up multiple times at night? Do little things irritate you more than usual? Higher scores on this questionnaire indicate a greater likelihood of experiencing vital exhaustion.

The link to cardiovascular health

Studying participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study, a long-term investigation to identify risk factors for atherosclerotic cardiovascular disease, researchers were able to find that those who had higher scores of vital exhaustion also had elevated Hs-TnT, NT-proBNP and Hs-CRP, biomarkers that are associated with heart muscle damage and inflammation. 

“The association between vital exhaustion and cardiovascular disease has been reported in previous studies but in our study, we showed an independent association between vital exhaustion and increased cardiac biomarker levels,” said Dr. Vijay Nambi, professor of medicine – cardiology at Baylor and a cardiologist at the Michael E. DeBakey Veterans Affairs Hospital. 

He added that these findings suggest that the physiologic stress of vital exhaustion (excessive fatigue, demoralization, sleep disturbance) can potentially result in cardiovascular injury regardless of a person’s traditional cardiac risk factors.

“Based on prior studies, we expected that adults with a higher number of cardiovascular risk factors would likely have a higher burden of vital exhaustion symptoms and cardiovascular injury. However, we also found an association between vital exhaustion and biomarkers of cardiovascular injury independent of these traditional risk factors,” said Dr. Matt Deshotels, fellow in the medicine – cardiology at Baylor.

Mental health matters

“Mental health and well-being are not among the traditional risk factors for cardiovascular disease, such as smoking, obesity and physical inactivity. But data are consistently showing that mental health considerations are vital for cardiovascular health,” Nambi said.

Dr. Glenn Levine, professor of medicine at Baylor and chair of the recent American Heart Association Scientific Statement on Psychological Health and Cardiovascular Risk and a co-author on this paper, agrees, stating that this is an important finding and study and contributes to our growing understanding of how psychological health can adversely impact cardiovascular risk.

Overall, the presence of both high levels of vital exhaustion and elevated biomarker levels were associated with a greater risk of a cardiovascular event and mortality.

“We are excited to contribute to this growing body of research. These findings emphasize the importance of prioritizing mindfulness and stress management in the prevention of cardiovascular disease,” Deshotels said.

Nambi added, “Our findings highlight the need to continue to investigate this connection and to identify interventions that improve mental health and in turn reduce cardiovascular events.”

To view the full study and to see all collaborators, funding information and disclosures, click here.