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Vasovagal Syncope Related to Emotional Stress Predicts Coronary Events in Later Life
Author(s) -
ZYSKO DOROTA,
MELANDER OLLE,
FEDOROWSKI ARTUR
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12138
Subject(s) - medicine , vasovagal syncope , interquartile range , hazard ratio , emotional stress , orthostatic vital signs , myocardial infarction , confidence interval , cardiology , syncope (phonology) , blood pressure
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.