Psychosocial Stress Linked to Heart Attacks in Men

Gregory M. Weiss, MD

A study from the ESC Acute CardioVascular Care 2021 Online Congress is providing clinicians with further insight into the effects of psychosocial stress on the cardiovascular health of men.

Stress has long been associated with a variety of medical conditions. Theories for this range from an increase in detrimental behaviors like eating, drinking, and smoking to systemic inflammation created by heightened sympathetic nervous system activity. Intense psychosocial stress has been associated with some severe forms of cardiac disease.

A form of heart failure known as Takotsubo cardiomyopathy, which is predominantly found in women, can occur after intense emotional stress such as the loss of a spouse and is known as broken heart syndrome. Dr. Dimitriy Panov, of the Institute of Cytology and Genetics, in Novosibirsk, Russia sought to determine if men experiencing extreme fatigue and stress, a condition called vital exhaustion, are at higher risk for heart attack than the general male population. Dr. Panov presented his findings at the ESC Acute CardioVascular Care 2021 Online Congress on March 14, 2021.

When asked what vital exhaustion is Dr. Panov states:

"Vital exhaustion refers to excessive fatigue, feelings of demoralization and increased irritability."

The purpose of this study was to see if heart attacks were occurring in men without prior cardiovascular disease who were suffering from vital exhaustion. Vital exhaustion was measured utilizing the Maastricht Vital Exhaustion Questionnaire and data were extracted from the World Health Organization via the MONICA project.

Vital exhaustion is thought to stem from exposure to intractable problems in the individual’s life including prolonged exposure to psychological stressors. Symptoms were classified as none, moderate, or high and patients were followed for 14 years with the primary outcome being experiencing a heart attack.

Dr. Panov and colleagues found that over two-thirds of the men studied had suffered from vial exhaustion. When compared to those without vital exhaustion, men with moderate or high levels had a nearly 3-fold greater risk of a heart attack within five years, a 2 ¼-fold greater risk within 10 years, and a 2-fold greater risk over 14 years. Interestingly the risk of heart attack in men with vital exhaustion was higher in widowed, divorced, and never married men than in married men. Dr. Panov believes that the reason for this finding is less social support.

"Living alone indicates less social support, which we know from our prior studies is an independent risk factor for myocardial infarction and stroke."

These findings could not have come at a better time. Over the last year, the global pandemic of COVID-19 has led to dramatic increases in social isolation, psycho-social and economic stress, and has resulted in unprecedented mortality leaving countless loved ones without a spouse, parent, or sibling. This combination of stressors represents a perfect storm capable of significantly increasing the incidence of vital exhaustion in the greater population. To make matters worse, evidence suggests that people experiencing acute coronary syndromes may be delaying or even foregoing travel to the hospital out of fear of coronavirus. We have to do better, on several levels, to combat these challenges head-on.

Looking at ways we can make a difference in this population, Dr. Panov suggests,

"Efforts to improve well-being and reduce stress at home and at work can help reduce vital exhaustion. Involvement in community groups is one way to increase social support and become less vulnerable to stress. Together with a healthy lifestyle, these measures should be beneficial for heart health."

Identifying men at risk for or experiencing vital exhaustion may prevent subsequent heart attacks if mitigating strategies aimed at reducing stress, eliminating isolation, and improving overall wellbeing are put into action. This may be accomplished through identification in the primary care setting of those at highest risk. This is a situation where mental health is closely linked to physical health and we as clinicians must look at the whole patient so as not to miss the forest for the tress. As specialists it is easy to focus on cardiovascular issues, that’s what we do, but we should be able to recognize the signs of vital exhaustion and realize that, even in seemingly healthy patients, the risk may be heightened for heart attacks.

Finally, credit should be given to Dr. Panov and colleagues for illuminating a hidden killer. In a time when mental health is in a fragile state, special attention should be paid to the effect extreme stress has on the hearts as well as the minds of men struggling to get by. Front line clinicians are the gatekeepers and with watchful eyes, we can protect their hearts and their lives.

This study, "Vital exhaustion and risk of myocardial infarction in male population aged 25- 64 years in Russia/Siberia. Epidemiological program WHO Monica-psychosocial," was presented virtually as part of the ESC Acute CardioVascular Care 2021 Online Congress.