The Full Body of Evidence on Chronic Exhaustion and Heart Disease

This was the first systematic attempt to formally collate the decades of research on vital exhaustion and coronary heart disease into a single, quantified body of evidence. Pooling 13 prospective studies covering more than 52,000 people, the review found vital exhaustion was associated with a 50 percent increased risk of coronary heart disease in people who started out healthy, and the risk climbed further, to roughly double, for a repeat event in people who already had established heart disease. A smaller pool of case-control studies found an even larger association, though that design carries its own limitations. There was also a link to heart failure risk, though based on only two studies.

As with any pooled analysis of observational research, this establishes association at scale rather than proof of a direct causal pathway, and the underlying studies used varying versions of the vital exhaustion questionnaire. What it accomplishes is settling, for the first time formally, a question that individual studies had circled around for over three decades: across the accumulated evidence, chronic exhaustion isn't a minor, soft correlate of heart disease, it's a consistently replicated risk factor on the same order as several better-known ones.