Association between mental stress–induced LF HRV change and rest LF HRV and the study endpoints in the pooled cohort
| . | Mental stress–induced LF HRV decrease . | . | . | Low rest HRV . | . | . | ||
|---|---|---|---|---|---|---|---|---|
| Yes (n = 498) . | No (n = 250) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)a . | Yes (n = 189) . | No (n = 559) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)b . | |
| Cardiovascular mortalityc | ||||||||
| Total no. of events | 32 | 5 | – | – | 14 | 23 | – | – |
| Rate per 100 person-years | 1.25 | 0.36 | 0.88 (0.36, 1.41) | – | 1.37 | 0.79 | 0.58 (−0.19, 1.35) | – |
| Model 1 | – | – | – | 3.48 (3.25, 3.73) | – | – | – | 1.75 (1.58, 1.94) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 3.54 (3.04, 4.12) | – | – | – | 2.14 (1.69, 2.72) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.92 (2.03, 4.21) | – | – | – | 1.64 (1.25, 2.17) |
| Model 4 = Model 3 + stress testingf | – | – | – | 3.02 (1.73, 5.25) | – | – | – | 1.8 (1.46, 2.22) |
| All-cause mortalityc | ||||||||
| Total no. of events | 54 | 11 | – | – | 22 | 43 | – | – |
| Rate per 100 person-years | 2.1 | 0.8 | 1.3 (0.58, 2.02) | – | 2.15 | 1.47 | 0.68 (−0.3, 1.66) | – |
| Model 1 | – | – | – | 2.66 (1.93, 3.67) | – | – | – | 1.47 (0.96, 2.25) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 2.68 (1.92, 3.73) | – | – | – | 1.43 (0.85, 2.41) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.67 (2.17, 3.27) | – | – | – | 1.34 (0.81, 2.2) |
| Model 4 = Model 3 + stress testingf | – | – | – | 2.51 (2.08, 3.02) | – | – | – | 1.38 (0.8, 2.4) |
| . | Mental stress–induced LF HRV decrease . | . | . | Low rest HRV . | . | . | ||
|---|---|---|---|---|---|---|---|---|
| Yes (n = 498) . | No (n = 250) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)a . | Yes (n = 189) . | No (n = 559) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)b . | |
| Cardiovascular mortalityc | ||||||||
| Total no. of events | 32 | 5 | – | – | 14 | 23 | – | – |
| Rate per 100 person-years | 1.25 | 0.36 | 0.88 (0.36, 1.41) | – | 1.37 | 0.79 | 0.58 (−0.19, 1.35) | – |
| Model 1 | – | – | – | 3.48 (3.25, 3.73) | – | – | – | 1.75 (1.58, 1.94) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 3.54 (3.04, 4.12) | – | – | – | 2.14 (1.69, 2.72) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.92 (2.03, 4.21) | – | – | – | 1.64 (1.25, 2.17) |
| Model 4 = Model 3 + stress testingf | – | – | – | 3.02 (1.73, 5.25) | – | – | – | 1.8 (1.46, 2.22) |
| All-cause mortalityc | ||||||||
| Total no. of events | 54 | 11 | – | – | 22 | 43 | – | – |
| Rate per 100 person-years | 2.1 | 0.8 | 1.3 (0.58, 2.02) | – | 2.15 | 1.47 | 0.68 (−0.3, 1.66) | – |
| Model 1 | – | – | – | 2.66 (1.93, 3.67) | – | – | – | 1.47 (0.96, 2.25) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 2.68 (1.92, 3.73) | – | – | – | 1.43 (0.85, 2.41) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.67 (2.17, 3.27) | – | – | – | 1.34 (0.81, 2.2) |
| Model 4 = Model 3 + stress testingf | – | – | – | 2.51 (2.08, 3.02) | – | – | – | 1.38 (0.8, 2.4) |
LF, low frequency; HRV, heart rate variability; HR, hazard ratio.
aThe HR compares the incidence of outcome events between participants based on those who had mental stress–induced HRV decrease vs. those with mental stress–induced HRV increase (reference). These models adjusted for low rest HRV. Robust confidence intervals are reported.
bThe HR compares the incidence of outcome events between participants who had low rest HRV, measured as the bottom quartile, and those with normal rest HRV, defined as those in the upper three quartiles. These models adjusted for mental stress–induced HRV decrease. Robust confidence intervals are reported.
cThe median observation period was 5.6 (IQR, 3.6–7.6).
dAge, sex, and race (Black v. non-Black participants).
eBody mass index, smoking status, history of hypertension, history of diabetes, history of dyslipidaemia, previous myocardial infarction (MIPS) or ischaemia (MIMS2) with ST changes, and heart failure were originally included. Variables that did not significantly change the effect size were removed, and only hyperlipidaemia and heart failure were retained.
fAbnormal myocardial perfusion by conventional stress testing was defined as > 4 difference between the summed rest and stress scores.
Association between mental stress–induced LF HRV change and rest LF HRV and the study endpoints in the pooled cohort
| . | Mental stress–induced LF HRV decrease . | . | . | Low rest HRV . | . | . | ||
|---|---|---|---|---|---|---|---|---|
| Yes (n = 498) . | No (n = 250) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)a . | Yes (n = 189) . | No (n = 559) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)b . | |
| Cardiovascular mortalityc | ||||||||
| Total no. of events | 32 | 5 | – | – | 14 | 23 | – | – |
| Rate per 100 person-years | 1.25 | 0.36 | 0.88 (0.36, 1.41) | – | 1.37 | 0.79 | 0.58 (−0.19, 1.35) | – |
| Model 1 | – | – | – | 3.48 (3.25, 3.73) | – | – | – | 1.75 (1.58, 1.94) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 3.54 (3.04, 4.12) | – | – | – | 2.14 (1.69, 2.72) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.92 (2.03, 4.21) | – | – | – | 1.64 (1.25, 2.17) |
| Model 4 = Model 3 + stress testingf | – | – | – | 3.02 (1.73, 5.25) | – | – | – | 1.8 (1.46, 2.22) |
| All-cause mortalityc | ||||||||
| Total no. of events | 54 | 11 | – | – | 22 | 43 | – | – |
| Rate per 100 person-years | 2.1 | 0.8 | 1.3 (0.58, 2.02) | – | 2.15 | 1.47 | 0.68 (−0.3, 1.66) | – |
| Model 1 | – | – | – | 2.66 (1.93, 3.67) | – | – | – | 1.47 (0.96, 2.25) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 2.68 (1.92, 3.73) | – | – | – | 1.43 (0.85, 2.41) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.67 (2.17, 3.27) | – | – | – | 1.34 (0.81, 2.2) |
| Model 4 = Model 3 + stress testingf | – | – | – | 2.51 (2.08, 3.02) | – | – | – | 1.38 (0.8, 2.4) |
| . | Mental stress–induced LF HRV decrease . | . | . | Low rest HRV . | . | . | ||
|---|---|---|---|---|---|---|---|---|
| Yes (n = 498) . | No (n = 250) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)a . | Yes (n = 189) . | No (n = 559) . | Rate difference per 100 person-years (95% CI) . | HR (95% CI)b . | |
| Cardiovascular mortalityc | ||||||||
| Total no. of events | 32 | 5 | – | – | 14 | 23 | – | – |
| Rate per 100 person-years | 1.25 | 0.36 | 0.88 (0.36, 1.41) | – | 1.37 | 0.79 | 0.58 (−0.19, 1.35) | – |
| Model 1 | – | – | – | 3.48 (3.25, 3.73) | – | – | – | 1.75 (1.58, 1.94) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 3.54 (3.04, 4.12) | – | – | – | 2.14 (1.69, 2.72) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.92 (2.03, 4.21) | – | – | – | 1.64 (1.25, 2.17) |
| Model 4 = Model 3 + stress testingf | – | – | – | 3.02 (1.73, 5.25) | – | – | – | 1.8 (1.46, 2.22) |
| All-cause mortalityc | ||||||||
| Total no. of events | 54 | 11 | – | – | 22 | 43 | – | – |
| Rate per 100 person-years | 2.1 | 0.8 | 1.3 (0.58, 2.02) | – | 2.15 | 1.47 | 0.68 (−0.3, 1.66) | – |
| Model 1 | – | – | – | 2.66 (1.93, 3.67) | – | – | – | 1.47 (0.96, 2.25) |
| Model 2 = Model 1 + demographic factorsd | – | – | – | 2.68 (1.92, 3.73) | – | – | – | 1.43 (0.85, 2.41) |
| Model 3 = Model 2 + cardiovascular risk factorse | – | – | – | 2.67 (2.17, 3.27) | – | – | – | 1.34 (0.81, 2.2) |
| Model 4 = Model 3 + stress testingf | – | – | – | 2.51 (2.08, 3.02) | – | – | – | 1.38 (0.8, 2.4) |
LF, low frequency; HRV, heart rate variability; HR, hazard ratio.
aThe HR compares the incidence of outcome events between participants based on those who had mental stress–induced HRV decrease vs. those with mental stress–induced HRV increase (reference). These models adjusted for low rest HRV. Robust confidence intervals are reported.
bThe HR compares the incidence of outcome events between participants who had low rest HRV, measured as the bottom quartile, and those with normal rest HRV, defined as those in the upper three quartiles. These models adjusted for mental stress–induced HRV decrease. Robust confidence intervals are reported.
cThe median observation period was 5.6 (IQR, 3.6–7.6).
dAge, sex, and race (Black v. non-Black participants).
eBody mass index, smoking status, history of hypertension, history of diabetes, history of dyslipidaemia, previous myocardial infarction (MIPS) or ischaemia (MIMS2) with ST changes, and heart failure were originally included. Variables that did not significantly change the effect size were removed, and only hyperlipidaemia and heart failure were retained.
fAbnormal myocardial perfusion by conventional stress testing was defined as > 4 difference between the summed rest and stress scores.
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