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Prognostic significance of ventricular arrhythmia modified by ability to adapt to stressful situations
Lena André-Petersson1, Gunnar Engström, Bo Hedblad
1Department of Community Medicine, Division of Epidemiology, Lund University, Malmö University Hospital, Malmö, Sweden. lena.andre-petersson@smi.mas.lu.se
Insights
Men with ventricular arrhythmias face higher risks of heart attack and death if they exhibit maladaptive behavior under stress. Adaptive behavior mitigates these risks, highlighting the importance of stress response in cardiovascular health.
Area of Science:
- Cardiology
- Psychophysiology
- Preventive Medicine
Background:
- Ventricular arrhythmia is a known risk factor for myocardial infarction and mortality.
- However, many individuals with this condition lead healthy lives, suggesting other factors influence prognosis.
- The prognostic significance of ventricular arrhythmia in relation to stress adaptation is not fully understood.
Purpose of the Study:
- To analyze the prognostic significance of frequent and complex ventricular arrhythmia.
- To investigate the role of stress adaptation ability in men with ventricular arrhythmias.
- To determine the association between stress behavior and cardiovascular outcomes.
Main Methods:
- Prospective cohort study design ('Men born in 1914').
- Inclusion of the serial Color Word Test to assess stress behavior (adaptive vs. maladaptive).
- 24-h ambulatory electrocardiographic recordings and follow-up for myocardial infarction and mortality over ~14 years.
Main Results:
- Ventricular arrhythmia was not associated with myocardial infarction or mortality in individuals with adaptive stress behavior.
- Ventricular arrhythmia combined with maladaptive behavior significantly increased the risk of myocardial infarction (RR 2.43) and all-cause mortality (RR 1.56).
Conclusions:
- Maladaptive behavior during stressful encounters increases vulnerability in men with ventricular arrhythmias.
- This vulnerability is linked to a higher risk of future myocardial infarction and overall mortality.
- Stress response is a critical factor modifying the prognosis of ventricular arrhythmias.
Background:
Ventricular arrhythmia is a risk factor for myocardial infarction and mortality but many individuals with this abnormality live long and healthy lives. The aim of this study is to analyse the prognostic significance of frequent and complex ventricular arrhythmia in men who differed regarding ability to adapt to a stressful situation.
Design:
Prospective cohort study.
Methods:
The serial Color Word Test is a semi-experimental way to assess how individuals behave in a stressful encounter. This test was included in the prospective cohort study 'Men born in 1914' together with 24-h ambulatory electrocardiographic recordings at a baseline examination in 1982/83. Behaviour in the test was categorized as either adaptive or maladaptive. Behaviour in the test and occurrence of ventricular arrhythmia at baseline were analyzed in relation to incidence of myocardial infarction and mortality during approximately 14 years of follow-up.
Results:
Multivariate analyses showed that ventricular arrhythmia was not associated with the incidence of myocardial infarction or all-cause mortality in the presence of an adaptive behaviour. Ventricular arrhythmia together with a maladaptive behaviour was associated with the incidence of myocardial infarction [relative risk (RR) 2.43; 95% confidence interval (CI) 1.37 to 4.31] and with all-cause mortality (RR 1.56; 95% CI 1.01 to 2.41) during follow-up.
Conclusions:
A maladaptive behaviour in a stressful encounter makes men with electrocardiographically detected ventricular arrhythmias more vulnerable and thereby exposed to an increased risk of a future myocardial infarction and overall mortality.
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