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Vasovagal Syncope Related to Emotional Stress Predicts Coronary Events in Later Life

Zysko, Dorota; Melander, Olle LU and Fedorowski, Artur LU (2013) In PACE 36(8). p.1000-1006
Abstract
Background: The aim of the study was to assess whether history of vasovagal syncope (VVS) mediated by emotional (emotional VVS) or orthostatic stress (orthostatic VVS) is associated with an increased risk of cardiovascular (CV) events in later life. Methods: Retrospective analysis based on medical records of the consecutive 3,288 cardiologic outpatients (mean age, 61 +/- 12 years; 43% men). Results: A total of 254 patients (7.7%) reported emotional VVS, whereas 294 (9.0%) had history of orthostatic VVS. First-ever syncopal episode was reported at a median age of 16 years (interquartile range [IQR], 12 years to 28 years), and the median total number of episodes was two (IQR, 1 to 5). There were 779 patients (23.7%) with at least one CV... (More)
Background: The aim of the study was to assess whether history of vasovagal syncope (VVS) mediated by emotional (emotional VVS) or orthostatic stress (orthostatic VVS) is associated with an increased risk of cardiovascular (CV) events in later life. Methods: Retrospective analysis based on medical records of the consecutive 3,288 cardiologic outpatients (mean age, 61 +/- 12 years; 43% men). Results: A total of 254 patients (7.7%) reported emotional VVS, whereas 294 (9.0%) had history of orthostatic VVS. First-ever syncopal episode was reported at a median age of 16 years (interquartile range [IQR], 12 years to 28 years), and the median total number of episodes was two (IQR, 1 to 5). There were 779 patients (23.7%) with at least one CV event, and the median age for the first CV event was 59 years (IQR, 52 years to 67 years). In the fully adjusted model, history of emotional VVS was predictive of CV event (hazard ratio [95% confidence interval]: 1.63, [1.27-2.09]; P < 0.001), myocardial infarction (1.99, [1.49-2.66]; P < 0.001), and percutaneous coronary intervention (1.84, [1.31-2.60]; P = 0.001). There was one significant interaction (P = 0.07) between history of emotional VVS and gender. Emotional VVS was predictive of CV event in men (1.89 [1.41-2.53]; P < 0.001) but not in women (1.24 [0.79-1.94]; P = 0.35). Conclusions: History of emotional but not orthostatic VVS is independently associated with increased risk of coronary events in later life. The relationship between predisposition to emotional VVS in adolescence and development of cardiovascular disease requires further studies. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
vasovagal syncope, myocardial infarction, cardiovascular disease, autonomic nervous system, psychological stress
in
PACE
volume
36
issue
8
pages
1000 - 1006
publisher
Wiley-Blackwell
external identifiers
  • wos:000322237700012
  • scopus:84880885292
ISSN
1540-8159
DOI
10.1111/pace.12138
language
English
LU publication?
yes
id
530ed52d-dc79-4b00-bcb1-1f351802dec0 (old id 4042874)
date added to LUP
2013-10-01 15:16:44
date last changed
2019-05-28 01:53:58
@article{530ed52d-dc79-4b00-bcb1-1f351802dec0,
  abstract     = {Background: The aim of the study was to assess whether history of vasovagal syncope (VVS) mediated by emotional (emotional VVS) or orthostatic stress (orthostatic VVS) is associated with an increased risk of cardiovascular (CV) events in later life. Methods: Retrospective analysis based on medical records of the consecutive 3,288 cardiologic outpatients (mean age, 61 +/- 12 years; 43% men). Results: A total of 254 patients (7.7%) reported emotional VVS, whereas 294 (9.0%) had history of orthostatic VVS. First-ever syncopal episode was reported at a median age of 16 years (interquartile range [IQR], 12 years to 28 years), and the median total number of episodes was two (IQR, 1 to 5). There were 779 patients (23.7%) with at least one CV event, and the median age for the first CV event was 59 years (IQR, 52 years to 67 years). In the fully adjusted model, history of emotional VVS was predictive of CV event (hazard ratio [95% confidence interval]: 1.63, [1.27-2.09]; P &lt; 0.001), myocardial infarction (1.99, [1.49-2.66]; P &lt; 0.001), and percutaneous coronary intervention (1.84, [1.31-2.60]; P = 0.001). There was one significant interaction (P = 0.07) between history of emotional VVS and gender. Emotional VVS was predictive of CV event in men (1.89 [1.41-2.53]; P &lt; 0.001) but not in women (1.24 [0.79-1.94]; P = 0.35). Conclusions: History of emotional but not orthostatic VVS is independently associated with increased risk of coronary events in later life. The relationship between predisposition to emotional VVS in adolescence and development of cardiovascular disease requires further studies.},
  author       = {Zysko, Dorota and Melander, Olle and Fedorowski, Artur},
  issn         = {1540-8159},
  keyword      = {vasovagal syncope,myocardial infarction,cardiovascular disease,autonomic nervous system,psychological stress},
  language     = {eng},
  number       = {8},
  pages        = {1000--1006},
  publisher    = {Wiley-Blackwell},
  series       = {PACE},
  title        = {Vasovagal Syncope Related to Emotional Stress Predicts Coronary Events in Later Life},
  url          = {http://dx.doi.org/10.1111/pace.12138},
  volume       = {36},
  year         = {2013},
}