The Heart Cost of Running on Empty

This meta-analysis pooled 11 prospective studies following more than 60,000 people who were free of heart disease at the start, all measuring a specific psychological state called vital exhaustion: not ordinary tiredness, but a persistent combination of excessive fatigue, increased irritability, and a sense of demoralisation. Across the pooled data, people scoring high on vital exhaustion had a 36 percent higher risk of a first cardiovascular event compared with those who didn't, placing it alongside anxiety, depression and social isolation as an established psychosocial risk factor rather than a soft or subjective concern.

As a meta-analysis of observational studies, it can show a strong, consistent association rather than prove that exhaustion itself directly damages the heart, and the studies included varied somewhat in how they measured exhaustion and defined outcomes. Its scale and consistency, though, 11 independent cohorts arriving at broadly the same conclusion, is precisely what makes vital exhaustion difficult to dismiss as incidental to cardiovascular health, and distinguishes it clearly from the popular but poorly supported idea of everyday willpower or self-control as a depletable resource, which large replication studies have since failed to confirm.