Vital exhaustion: behavioural and biological correlates

Abstract

Cardiovascular disease remains the leading cause of mortality in the western world. The absence of smoking, hypertension, hyperlipidaemia, diabetes and a sedentary lifestyle in over 50% of patients with atherosclerosis indicates that additional risk factors remain to be identified. One putative risk factor is vital exhaustion, a state characterized by fatigue, irritability, and general malaise that precedes the onset of coronary artery disease in more than half of all cases. Although epidemiological studies have shown that vital exhaustion predicts cardiovascular disease in both healthy and cardiac populations, the origin of these symptoms is poorly understood.

Stress-related changes in haemostasis and infections/inflammation may constitute important pathways that link vital exhaustion with cardiovascular disease. In line with these findings, the hypothesis is put forward that the exhaustion before a cardiac event in fact reflects an adaptive response of the host that is triggered by pro-inflammatory cytokines during an infectious period.

A better understanding of stress-related immune dysregulation not only enhances the knowledge of specific psychobiological mechanisms in cardiovascular disease, but also gives insight into the origins of the mental state of coronary patients.