Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study

Heart. 2018 Mar;104(5):423-429. doi: 10.1136/heartjnl-2017-311825. Epub 2017 Sep 19.


Objective: Vital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study.

Methods: The ARIC Study is a predominately biracial cohort of men and women, aged 45-64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores.

Results: Through 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20).

Conclusions: Among participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

Keywords: epidemiology.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Atherosclerosis / ethnology
  • Atherosclerosis / mortality
  • Death, Sudden, Cardiac / epidemiology*
  • Death, Sudden, Cardiac / ethnology
  • Fatigue / ethnology
  • Fatigue / mortality*
  • Fatigue / physiopathology
  • Fatigue / psychology
  • Female
  • Health Status
  • Humans
  • Irritable Mood
  • Male
  • Mental Fatigue / ethnology
  • Mental Fatigue / mortality*
  • Mental Fatigue / physiopathology
  • Mental Fatigue / psychology
  • Mental Health
  • Middle Aged
  • Prognosis
  • Risk Factors
  • United States / epidemiology