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Salari N, Karimi Z, Hemmati M, Mohammadi A, Shohaimi S, Mohammadi M. Global prevalence of vasovagal syncope: A systematic review and meta-analysis. GLOBAL EPIDEMIOLOGY 2024; 7:100136. [PMID: 38283939 PMCID: PMC10821537 DOI: 10.1016/j.gloepi.2024.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/18/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Background Today, vasovagal syncope is a common problem that has become a significant health and social challenge. The present study investigated the global prevalence of vasovagal syncope using a systematic review and meta-analysis.Methods: In this systematic review and meta-analysis study, the global prevalence of vasovagal syncope using the keywords Prevalence, Epidemiology, Vasovagal syncope, and Reflex syncope in PubMed, WoS, Scopus, ScienceDirect databases, and Google scholar search engine without time limit until July 20, 2022, was extracted and transferred to the information management software (EndNote). Then the repeated studies were excluded, and researchers evaluated the remaining studies during three stages (i.e., screening, eligibility, and qualitative assessment). The heterogeneity of studies was investigated using the I2 index, and the analysis of eligible studies was performed using the random effects model. Results In the review of 12 studies with a sample size of 36,156 people, the global prevalence of vasovagal syncope was reported as 16.4 (95%CI: 6-37.5), and the study of publication bias in the studies through the Egger test shows the absence of publication bias in the studies. Conclusion The prevalence reported in the studies shows a high prevalence of vasovagal syncope, which requires serious intervention and preventive, diagnostic, and therapeutic measures. It is necessary for health policymakers to take effective measures in this field.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zohre Karimi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahvan Hemmati
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Mohammadi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
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Hatoum T, Raj S, Sheldon RS. Current approach to the treatment of vasovagal syncope in adults. Intern Emerg Med 2023; 18:23-30. [PMID: 36117230 DOI: 10.1007/s11739-022-03102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Vasovagal syncope (VVS) is the most common cause of transient loss of consciousness. Although not associated with mortality, it causes injuries, reduces quality of life, and is associated with anxiety and depression. The European and North American cardiac societies recently published syncope clinical practice guidelines. Most patients with VVS do well after specialist evaluation, reassurance and education. Adequate hydration, increased salt intake when not contraindicated, and careful withdrawal of diuretics and specific hypotension-inducing drugs are a reasonable initial strategy. Physical counterpressure maneuvers might be helpful but can be of limited efficacy in older patients and those with short or no prodromes. Orthostatic training lacks long term efficacy and is troubled by non-compliance. Yoga might be helpful, although the biomedical mechanism is unknown. Almost a third of VVS patients continue to faint despite these conservative measures. Metoprolol was not helpful in a pivotal randomized clinical trial. Fludrocortisone and midodrine significantly reduce syncope recurrences with tolerable side effects, when titrated to target doses. Pacing therapy with specialized sensors appears promising in carefully selected population who have not responded conservative measures. Cardioneuroablation may be helpful but has not been studied in a formal clinical trial.
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Affiliation(s)
- Tarek Hatoum
- Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Satish Raj
- Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Robert Stanley Sheldon
- Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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Matveeva N, Titov B, Bazyleva E, Pevzner A, Favorova O. Towards Understanding the Genetic Nature of Vasovagal Syncope. Int J Mol Sci 2021; 22:10316. [PMID: 34638656 PMCID: PMC8508958 DOI: 10.3390/ijms221910316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Syncope, defined as a transient loss of consciousness caused by transient global cerebral hypoperfusion, affects 30-40% of humans during their lifetime. Vasovagal syncope (VVS) is the most common cause of syncope, the etiology of which is still unclear. This review summarizes data on the genetics of VVS, describing the inheritance pattern of the disorder, candidate gene association studies and genome-wide studies. According to this evidence, VVS is a complex disorder, which can be caused by the interplay between genetic factors, whose contribution varies from monogenic Mendelian inheritance to polygenic inherited predisposition, and external factors affecting the monogenic (resulting in incomplete penetrance) and polygenic syncope types.
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Affiliation(s)
- Natalia Matveeva
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
- Department of Molecular Biology and Medical Biotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Boris Titov
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
- Department of Molecular Biology and Medical Biotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Elizabeth Bazyleva
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
| | - Alexander Pevzner
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
| | - Olga Favorova
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
- Department of Molecular Biology and Medical Biotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
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Sheldon RS, Gerull B. Genetic markers of vasovagal syncope. Auton Neurosci 2021; 235:102871. [PMID: 34474354 DOI: 10.1016/j.autneu.2021.102871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 12/18/2022]
Abstract
Vasovagal syncope may have a genetic predisposition. It has a high prevalence in some families, and children of a fainting parent are more likely to faint than those without a parent who faints. Having two fainting parents or a fainting twin increases the likelihood even further. Several genotypes appear to associate with the phenotype of positive tilt tests, but the control subjects are usually those who faint and have negative tilt tests. Twin studies, highly focused genome-wide association studies, and copy number variation studies all suggest there are loci in the genome that associate with vasovagal syncope, although the specific genes, pathways, and proteins are unknown. A recent multigenerational kindred candidate gene study identified 3 genes that associate with vasovagal syncope. The best evidence to date is for central signaling genes involving serotonin and dopamine. Genome-wide association studies to date have not yet been helpful. Our understanding of the genetic correlates of vasovagal syncope leaves ample opportunity for future work.
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Affiliation(s)
- Robert S Sheldon
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada; Department of Internal Medicine I and Comprehensive Heart Failure Center, University of Würzburg, Germany.
| | - Brenda Gerull
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada; Department of Internal Medicine I and Comprehensive Heart Failure Center, University of Würzburg, Germany
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Hadji-Turdeghal K, Andreasen L, Hagen CM, Ahlberg G, Ghouse J, Bækvad-Hansen M, Bybjerg-Grauholm J, Hougaard DM, Hedley P, Haunsø S, Svendsen JH, Kanters JK, Jepps TA, Skov MW, Christiansen M, Olesen MS. Genome-wide association study identifies locus at chromosome 2q32.1 associated with syncope and collapse. Cardiovasc Res 2020; 116:138-148. [PMID: 31049583 PMCID: PMC6918066 DOI: 10.1093/cvr/cvz106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Syncope is a common condition associated with frequent hospitalization or visits to the emergency department. Family aggregation and twin studies have shown that syncope has a heritable component. We investigated whether common genetic variants predispose to syncope and collapse. METHODS AND RESULTS We used genome-wide association data on syncope on 408 961 individuals with European ancestry from the UK Biobank study. In a replication study, we used the Integrative Psychiatric Research Consortium (iPSYCH) cohort (n = 86 189), to investigate the risk of incident syncope stratified by genotype carrier status. We report on a genome-wide significant locus located on chromosome 2q32.1 [odds ratio = 1.13, 95% confidence interval (CI) 1.10-1.17, P = 5.8 × 10-15], with lead single nucleotide polymorphism rs12465214 in proximity to the gene zinc finger protein 804a (ZNF804A). This association was also shown in the iPSYCH cohort, where homozygous carriers of the C allele conferred an increased hazard ratio (1.30, 95% CI 1.15-1.46, P = 1.68 × 10-5) of incident syncope. Quantitative polymerase chain reaction analysis showed ZNF804A to be expressed most abundantly in brain tissue. CONCLUSION We identified a genome-wide significant locus (rs12465214) associated with syncope and collapse. The association was replicated in an independent cohort. This is the first genome-wide association study to associate a locus with syncope and collapse.
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Affiliation(s)
- Katra Hadji-Turdeghal
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laura Andreasen
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian M Hagen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Gustav Ahlberg
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Ghouse
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bækvad-Hansen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Jonas Bybjerg-Grauholm
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - David M Hougaard
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Paula Hedley
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | - Stig Haunsø
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas A Jepps
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten W Skov
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Christiansen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten S Olesen
- Laboratory for Molecular Cardiology, Department of Cardiology, The Heart Centre, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sheldon RS, Sandhu RK. The Search for the Genes of Vasovagal Syncope. Front Cardiovasc Med 2019; 6:175. [PMID: 31850372 PMCID: PMC6892747 DOI: 10.3389/fcvm.2019.00175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Only humans faint, and not all do so. Syncope tends to recur, and the predisposition to syncope can persist over many decades. Observations such as these have suggested that there may be a genetic predisposition to vasovagal syncope. It seems to have a high prevalence in some families; having a parent who faints increases the likelihood of an offspring fainting, and this is increased even further if both biological parents faint. Numerous studies have correlated a number of genotypes with positive tilt tests. However, the control subjects are usually those who faint, but have negative tilt tests, making the conclusions about association with the clinical phenotype less certain. Twin studies, highly focused genome-wide association studies, and gene duplicate studies all suggest there are sites in the genome that associate with vasovagal syncope, although the specific genes, pathways, and proteins are unknown. A recent large, candidate gene study of kindreds with high, multigenerational prevalence of the vasovagal syncope identified 3 genes that associate with vasovagal syncope. Our understanding of the genetic correlates of vasovagal syncope is in its infancy, with much to be understood.
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Affiliation(s)
- Robert S Sheldon
- The Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.,The Mazankowski Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Roopinder K Sandhu
- The Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.,The Mazankowski Heart Institute, University of Alberta, Edmonton, AB, Canada
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Sheldon R, Rose MS, Ritchie D, Martens K, Maxey C, Jagers J, Parboosingh J, Gerull B. Genetic Association Study in Multigenerational Kindreds With Vasovagal Syncope: Evidence for Involvement of Sex-Specific Serotonin Signaling. Circ Arrhythm Electrophysiol 2019; 12:e006884. [PMID: 30636478 DOI: 10.1161/circep.118.006884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies suggest that vasovagal syncope has a genetic origin, but this is unclear. We assessed whether plausible gene variants associate with vasovagal syncope. METHODS We studied 160 subjects in 9 kindreds comprising 82 fainters and 78 controls. The diagnosis was ascertained with the Calgary Syncope Score. Common genetic variants were genotyped for 12 genes for vascular signaling, potassium channels, the HTR1A(serotonin 5-HT1A receptor), SLC6A4(serotonin reuptake transporter), and COMT(catecholamine O-methyltransferase). Sex-specific associations between genotypes and phenotypes were tested. RESULTS In 9 out of 12 variants, there was no significant association between genotype and phenotype. However, the HTR1A(-1019) G alleles associated with syncope in males, but not in females ( P=0.005). CC and GG males had 9% versus 77% likelihoods of syncope. The SLC6A4 promoter L alleles associated with decreased syncope in males but increased in females ( P=0.059). The LL and SS males had 25% and 47% syncope likelihoods, whereas females had 75% and 50% syncope likelihoods. The COMT c.472 A alleles associated with decreased syncope in males but increased in females ( P=0.017). The GG and AA males had 50% and 15% syncope likelihoods, whereas females had 52% and 73% syncope likelihoods. CONCLUSIONS There is a sex-dependent effect of alleles of serotonin signaling and vasovagal syncope, supporting the serotonin hypothesis of the physiology of vasovagal syncope.
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Affiliation(s)
- Robert Sheldon
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - M Sarah Rose
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Debbie Ritchie
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Kristina Martens
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Connor Maxey
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Jennie Jagers
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Jillian Parboosingh
- Alberta Children's Hospital Research Institute, University of Calgary, Canada (J.P.)
| | - Brenda Gerull
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.).,Department Kardiovasculare Genetik, University Hospital Würzburg and University Würzburg, Germany (B.G.)
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