Abstract
BackgroundFatigue and psychophysiological reactions to mental stress are known to be problematic in coronary artery disease (CAD) patients. Currently, studies exploring the relationship between fatigue and cardiovascular reactivity to stress are scarce and inconsistent. The current study aimed to investigate the links between cardiovascular response to mental stress and fatigue in CAD patients after acute coronary syndrome (ACS).MethodsThe cross-sectional study investigated 142 CAD patients (85% males, 52 ± 8 years) within 2–3 weeks after recent myocardial infarction or unstable angina pectoris. Fatigue symptoms were measured using Multidimensional Fatigue Inventory 20-items, while cardiovascular reactivity to stress [i.e., systolic (S) and diastolic (D) blood pressure (ΔBP), and heart rate (ΔHR)] was evaluated during Trier Social Stress Test (TSST). In addition, participants completed psychometric measures, including the Hospital Anxiety and Depression scale and the Type D Scale-14. Multivariable linear regression analyses were completed to evaluate associations between fatigue and cardiovascular response to TSST, while controlling for confounders.ResultsAfter controlling for baseline levels of cardiovascular measures, age, gender, education, heart failure severity, arterial hypertension, smoking history, use of nitrates, anxiety and depressive symptoms, Type D Personality, perceived task difficulty, and perceived task efforts, cardiovascular reactivity to anticipatory stress was inversely associated with both global fatigue (ΔHR: β = –0.238; p = 0.04) and mental fatigue (ΔSBP: β = –0.244; p = 0.04; ΔHR β = –0.303; p = 0.01) as well as total fatigue (ΔSBP: β = –0.331; p = 0.01; ΔHR: β = –0.324; p = 0.01).ConclusionIn CAD patients after ACS, fatigue was linked with diminished cardiovascular function during anticipation of a mental stress challenge, even after inclusion of possible confounders. Further similar studies exploring other psychophysiological stress responses are warranted.
Highlights
Despite medical advances that have improved coronary artery disease (CAD) outcomes over the past fifty years, CAD remains the most common cause of premature mortality, accounting for almost one third of all deaths worldwide (Piepoli et al, 2016; AlMallah et al, 2018)
Considering the limited and inconsistent research regarding fatigue and its effects on cardiovascular response during mental stress, the current study aimed to investigate the relationship between cardiovascular response to mental stress and subjective fatigue in patients with CAD after acute coronary syndrome (ACS)
Based on the criteria outlined above, 17 univariate outliers were identified, which were removed from the analysis
Summary
Despite medical advances that have improved coronary artery disease (CAD) outcomes over the past fifty years, CAD remains the most common cause of premature mortality, accounting for almost one third of all deaths worldwide (Piepoli et al, 2016; AlMallah et al, 2018). CAD typically includes diagnoses of angina pectoris, and may lead to acute coronary syndrome (ACS) (De Lemos and Omland, 2017). Prolonged psychological stress may disrupt biological regulatory systems, such as ANS, and so may lead to maladaptive blunted cardiovascular response (Hughes et al, 2018). Even though there are no clear cut-off points for determining whether the cardiovascular response is exaggerated or diminished (often referred to as “blunted”) (Turner, 1994), a burgeoning scientific literature suggests that blunted stress reactions are themselves associated with adverse health outcomes (Phillips et al, 2013). Fatigue and psychophysiological reactions to mental stress are known to be problematic in coronary artery disease (CAD) patients. The current study aimed to investigate the links between cardiovascular response to mental stress and fatigue in CAD patients after acute coronary syndrome (ACS)
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