Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease

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.

Cortisol response to psychosocial stress, mental distress, fatigue and quality of life in coronary artery disease patients

“…Several studies in individuals with CAD suggested links between subjectively perceived stress and fatigue 31,32 . In terms of objectively observed psychophysiological stress markers, in our recent study 33 we found diminished cardiovascular reactivity to stress linked with higher levels of fatigue during anticipation of mental stress challenge, suggesting fatigue as a possible variable contributing to dysregulated psychophysiological response to stress in those after recent ACS. Nevertheless, even though the interplay between cortisol stress reactivity and fatigue has been extensively studied in persons with chronic fatigue syndrome [34][35][36] , there was no study that explored cortisol response to psychosocial stress and its interplay with fatigue in individuals with ACS.…”

“…The MFI-20 covers five subscales: (1) general fatigue, (2) physical fatigue, (3) mental fatigue, (4) reduced activity, and (5) reduced motivation. Each domain consists of four items with possible answers on a five-point Likert scale (1 = “yes, that is true”; 5 = “no, that is not true”) 33 . The domain of General fatigue is composed of the general statements about fatigue and reduced functioning, covering physical as well as psychological aspects of fatigue.…”

Cortisol Response to Psychosocial Stress in Coronary Artery Disease Patients: The Role of Mental Distress, Fatigue and Quality of Life

“…Several studies in individuals with CAD suggest links between subjectively perceived stress and fatigue 27,28 . In terms of objectively observed psychophysiological stress markers, in our recent study 29 we found that in individuals with CAD after ACS the diminished cardiovascular reactivity to stress was linked with higher levels of fatigue during anticipation of mental stress challenge, suggesting fatigue as a possible variable that may contribute to dysregulated psychophysiological response to stress. Nevertheless, even though the interplay between cortisol stress reactivity and fatigue has been extensively studied in persons with chronic fatigue syndrome [30][31][32] , to our knowledge, there is no study that explored cortisol response to psychosocial stress and its interplay with fatigue in individuals with ACS.…”

“…The MFI, consisting of 20 items covers ve subscales: (1) general fatigue, (2) physical fatigue, (3) mental fatigue, (4) reduced activity, and (5) reduced motivation. Each domain consists of four items with possible answers on a ve-point Likert scale (1 = "yes, that is true"; 5 = "no, that is not true") 29 . The domain of General fatigue is composed of the general statements about fatigue and reduced functioning, covering physical as well as psychological aspects of fatigue.…”

Attenuated Cardiovascular Reactivity to Acute Psychological Stress Predicts Future Fatigue Symptoms in Truck Drivers

“…38 Although our study did not adjust statistically for subjective efforts, other comparable studies have, and significant associations remained for fatigue, anxiety, and depressive symptoms. 20,39 Whereas it was beyond the scope of this study to identify causal pathways, future research should aim to identify biological mechanisms that underlie our results. It could be that individuals with relatively lower HR or BP who show low reactivity are more resistant to the physiological impacts of mild stressors, and this low reactivity would likely be associated with positive outcomes.…”