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).
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).
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.
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).
Elevated stress was associated with incident HFpEF but not HFrEF.
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