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Vital exhaustion in women with chest pain and no obstructive coronary artery disease: the iPOWER study
  1. Daria Frestad Bechsgaard1,
  2. Ida Gustafsson2,
  3. Marie Mide Michelsen2,
  4. Naja Dam Mygind3,
  5. Adam Pena4,
  6. Hannah Elena Suhrs2,
  7. Kira Bove2,
  8. Jens Dahlgaard Hove1,5,
  9. Eva Prescott2
  1. 1Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
  2. 2Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
  3. 3Cardiology, Rigshospitalet, Copenhagen, Denmark
  4. 4Cardiology, Gentofte University Hospital, Hellerup, Denmark
  5. 5Center for Functional and Diagnostic Imaging, Hvidovre University Hospital, Hvidovre, Denmark
  1. Correspondence to Dr Daria Frestad Bechsgaard, Cardiology, Hvidovre Hospital, Hvidovre 2650, Denmark; daria.frestad{at}


Background More than half of women with symptoms suggestive of myocardial ischaemia have no obstructive coronary artery disease (CAD), yet they face a higher risk of cardiovascular mortality and morbidity. Both vital exhaustion (VE) and depression have been linked to adverse cardiovascular prognosis in patients with CAD. We aimed to assess whether symptomatic women with no obstructive CAD are more vitally exhausted compared with asymptomatic women. Furthermore, we investigated the overlap between the constructs of VE and depression.

Methods Prevalence and burden of VE was assessed in symptomatic women with no obstructive CAD (n=1.266) and asymptomatic women (n=2.390). Among symptomatic women, we also assessed chest pain characteristics and symptoms of Hospital Anxiety and Depression Questionnaire.

Findings Median (IQR) VE score was 4 (1-9) and 2 (0–5) in symptomatic and asymptomatic women, respectively (age adjusted, p<0.001). The risk of severe VE was significantly higher in symptomatic women compared with asymptomatic women (OR 3.3, 95% CI 2.5 to 4.4), independent of age and risk factors, and was associated with symptom severity. VE and depression scores were correlated but principal component cluster analysis (PCCA) showed clear distinctiveness between the two constructs.

Conclusions Women with chest pain and no obstructive CAD are more vitally exhausted compared with asymptomatic women. PCCA showed that VE is distinct from depression in symptomatic women.

Clinical implications Mental health screening focusing on depressive symptomatology in women with chest pain presenting with symptoms of mental and physical exhaustion may overlook VE in these patients.

  • depression & mood disorders

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  • Contributors All coauthors, listed on the title page, have participated in the planning, execution or analysis of the study and resulting manuscript. The submitted version of the manuscript has been read and approved by all coauthors. The authors report no conflict of interest.

  • Funding The iPOWER study is funded by the Danish Heart Foundation. DFB is funded by the Arvid Nilssons Foundation and Hvidovre University Hospital Research Council.

  • Competing interests No, there are no competing interests.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by The Danish Regional Committee on Biomedical Research Ethics (H-3-2012-005).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data will be made available on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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