Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

Q: What are the key findings of this study?

Exhaustion symptoms were indirectly associated with higher cardiovascular risk factors through reduced vagally-mediated heart rate variability in adults aged 54.27 years and older.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Exhaustion symptoms and cardiovascular disease risk factors (n=388). Intervention: Exhaustion symptoms (MBI-GS-D) mediated by vagally-mediated heart rate variability (lnRMSSD). Primary outcome: Cumulative self-reported physician-diagnosed CVD risk score (sum of hypertension, hypercholesterolemia, and diabetes; range 0-3) via conditional indirect effect of exhaustion through vmHRV at age 54.27 years (Indirect effect 0.014, 95% CI 0.001-0.033).

Q: What does this research mean for the field?

Exhaustion symptoms are indirectly associated with higher cardiovascular disease risk factors through reduced vagally-mediated heart rate variability specifically in middle-aged and older adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Magdalena Wekenborg; Richard G. Künzel; Nicole Rothe; Marlene Penz; Andreas Walther; Clemens Kirschbaum; Julian F. Thayer; LaBarron K. Hill

doi:10.1016/j.annepidem.2023.09.008

September 23, 2023Annals of EpidemiologyOpen Access

Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

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Key result

Exhaustion symptoms are linked to higher cardiovascular risk in older adults, mediated by reduced HRV.

Indirect effect 0.014
95% CI 0.001-0.033
n=388

Why the study?

Exhaustion symptoms are associated with cardiovascular disease risk, but the underlying mechanisms remain unclear.

Does vagally-mediated heart rate variability mediate the association between exhaustion symptoms and self-reported cardiovascular disease risk factors in an age-dependent manner?

Key Points

To examine whether vagally-mediated heart rate variability mediates the association between exhaustion symptoms and cardiovascular disease risk factors, and whether this indirect effect depends on age.
Analyzed cross-sectional data from the Dresden Burnout Study including 388 participants (72.9% female; mean age = 42.61 years, SD = 11.67; age range 20–68 years).
Assessed exhaustion via the Maslach Burnout Inventory-General Survey, vagally-mediated heart rate variability using resting root mean square of successive differences, and self-reported cardiovascular risk factors.
Tested direct and indirect effects using moderated mediation analysis (Hayes Process Model 59) adjusting for sex, body mass index, depressive symptoms, smoking, caffeine, and alcohol consumption.
In the unmoderated model, neither the direct path from exhaustion to cardiovascular risk (B ≤ −0.01, SE = 0.02, 95% CI [−0.04, 0.03]) nor the indirect path via heart rate variability (ab ≤ 0.01, SE ≤ 0.01, 95% CI [< −0.01, 0.01]) reached statistical significance.
Age significantly moderated the relationship between heart rate variability and cardiovascular risk (F(1377) = 11.34, P < .001, R² = 0.02; interaction B = −0.01, P < .001).
The conditional indirect association between exhaustion and cardiovascular risk through heart rate variability was positive and significant only in individuals aged 54.27 years and older (effect = 0.014, SE = 0.008, 95% bootstrap CI [0.001, 0.033]).

Study Design

Type

Cross-Sectional (n=388)

Multicenter

No

Structured PICO

Does vagally-mediated heart rate variability mediate the association between exhaustion symptoms and self-reported cardiovascular disease risk factors in an age-dependent manner?

P

Population

388 German-speaking adults (mean age 42.61 years, 72.9% female) from the Dresden Burnout Study evaluated cross-sectionally for exhaustion symptoms, resting vagally-mediated heart rate variability, and self-reported cardiovascular risk factors.

E

Exposure

Exhaustion symptoms (measured via the 5-item exhaustion subscale of the German version of the Maslach Burnout Inventory-General Survey [MBI-GS-D]) and resting vagally-mediated heart rate variability (vmHRV, operationalized as log-transformed root mean square of successive differences [lnRMSSD] from a 335-second seated resting R-R interval recording).

O

Outcome

Cumulative cardiovascular disease (CVD) risk score (0 to 3), calculated as the sum of self-reported presence (1) or absence (0) of physician-diagnosed hypertension, hypercholesterolemia, and diabetes.patient reported

Main Result

Effect estimate: Indirect effect 0.014 (95% CI 0.001-0.033)

This study provides evidence that autonomic imbalance (reduced vagally-mediated heart rate variability) serves as an age-dependent biological mediator linking burnout-related exhaustion symptoms to cardiovascular risk factors in middle-aged and older adults.

Limitations

Cross-sectional analysis utilizing a single wave of the Dresden Burnout Study, preventing conclusions about causality or directionality.
CVD risk was operationalized as a simple sum score of self-reported physician-diagnosed hypertension, hypercholesterolemia, and diabetes without objective biological data or family history, introducing potential misclassification or under-reporting.
Lower number of male participants (27.1%) and lower statistical power in sex-specific subgroup analyses.
Cross-sectional design utilizing a single wave of the Dresden Burnout Study precludes conclusions about causality or directionality
Reliance on self-reported physician diagnoses for hypertension, hypercholesterolemia, and diabetes rather than objective biological measurements, creating potential for outcome misclassification or under-reporting
Use of a simple cumulative CVD risk sum score that omitted family history of CVD
Lower proportion of male participants (27.1%, n=105), limiting statistical power in sex-specific sensitivity analyses

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Implication

Hypothesis-generating for age-dependent vagal mediation of exhaustion-related risk; prospective studies needed before clinical consideration.

Abstract

Exhaustion symptoms are known to be associated with cardiovascular disease (CVD) risk; however, the underlying mechanisms remain unclear. Autonomic imbalance, as indicated by reductions in vagally-mediated heart rate variability (vmHRV), appears to be a valid candidate for such a biological link, as it has been associated with both exhaustion symptoms and CVD risk and mortality. The present study examined a potential mediation of vmHRV on the association between exhaustion symptoms and self-reported CVD risk factors as well as the age dependency of this mediation in a large, heterogeneous sample of the Dresden Burnout Study (N = 388; 72.9% females; Mage = 42.61, SD = 11.67). Results indicate that exhaustion symptoms were indirectly associated with CVD risk factors through vmHRV even after adjusting for well-known confounders (i.e., sex, BMI, depressive symptoms). Moreover, this pattern was significant only among middle-aged (i.e., 54.27 years) and older individuals. Our findings add to growing evidence that autonomic imbalance may be a key biological link between exhaustion symptoms and CVD risk in middle-aged and older individuals. Implications for public health are discussed.

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Cite This Study

Wekenborg et al. (2023) conducted a cross-sectional in Exhaustion symptoms and cardiovascular disease risk factors (n=388). Exhaustion symptoms (MBI-GS-D) mediated by vagally-mediated heart rate variability (lnRMSSD) was evaluated on Cumulative self-reported physician-diagnosed CVD risk score (sum of hypertension, hypercholesterolemia, and diabetes; range 0-3) via conditional indirect effect of exhaustion through vmHRV at age 54.27 years (Indirect effect 0.014, 95% CI 0.001-0.033). Exhaustion symptoms were indirectly associated with higher cardiovascular risk factors through reduced vagally-mediated heart rate variability in adults aged 54.27 years and older.

synapsesocial.com/papers/6a83112f114d53034e9c8691 https://doi.org/10.1016/j.annepidem.2023.09.008

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Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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