Introduction
Given its known role in activating inflammatory and neurohormonal pathways, psychological
stress may be an important yet understudied risk factor for incident heart failure
(HF).
Hypothesis
We hypothesized that high perceived stress levels would be associated with incident
HF with reduced ejection fraction (HFrEF) and incident HF with preserved ejection
fraction (HFpEF).
Methods
We utilized data from the national REasons for Geographic And Racial Differences in
Stroke (REGARDS) study, a large prospective biracial cohort study that enrolled community-dwellers
aged 45 years and older between 2003 and 2007. We included participants free of suspected
HF at baseline who completed the 4-item Perceived Stress Scale (PSS-4) questionnaire.
Our primary outcome was the first adjudicated HF hospitalization or HF death through
the end of 2016. We used sequentially-adjusted Cox proportional hazard models to determine
if stress was independently associated with incident HF, adjusting for sociodemographics,
medical comorbidities, and physiologic parameters.
Results
Among 25,785 participants of mean age 64 years, 55% were female and 40% were black.
Over a median follow-up of 10.1 years, 1109 (4.3%) had an incident HF event (356 HFpEF
events and 465 HFrEF events). Compared to participants in the lowest PSS-4 quartile,
participants in the highest quartile were more likely to be female, black, and have
annual household incomes <$35k. After adjusting for sociodemographic and physiologic
variables, the hazard ratios (HRs) for incident HFpEF were elevated for quartiles
2-4 compared to the lowest quartile; for incident HFrEF, the HRs were similar across
all 4 quartiles and not statistically significant (Figure 1).
Conclusions
Elevated stress was associated with incident HFpEF but not HFrEF.
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Article info
Identification
Copyright
© 2020 Published by Elsevier Inc.
