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We studied the relationship of electrocardiographic measures of autonomic dysfunction during acute mental stress provocation and CVD death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In a pooled cohort of 765 participants with stable CVD from two related studies, we collected Holter data during standardized laboratory-based mental stress testing with a speech task and followed them for events. We assessed autonomic function using low-frequency (LF) heart rate variability (HRV) in 5-min intervals before, during, and after stress induction, and specifically examined changes from rest to stress. We employed cause-specific survival models to examine its association with CVD and all-cause mortality, controlling for demographic and CVD risk factors. The mean (SD) age was 58 (10) years, 35% were women, and 44% self-identified as Black. After a median follow-up of 5.6 years, 37 (5%) died from CVD causes. A stress-induced LF HRV decrease (67% of sample), vs. increase, was associated with a hazard ratio (HR) of 3.48 (95% confidence interval\u20143.25, 3.73) for CVD mortality. Low rest LF HRV (bottom quartile) was also independently associated with CVD mortality, HR = 1.75 (1.58, 1.94), vs. normal rest LF HRV (upper three quartiles). The combination of stress-induced LF HRV decrease and low rest LF HRV was associated with HR = 5.73 (5.33, 6.15) vs. the normal stress\/rest LF HRV reference. We found similar results with HF HRV.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Stress-induced LF HRV decrease and low rest LF HRV are both independently and additively associated with a higher CVD mortality risk. Additional research is needed to assess whether targeting autonomic dysfunction may improve CVD outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeae086","type":"journal-article","created":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T16:41:05Z","timestamp":1729010465000},"source":"Crossref","is-referenced-by-count":16,"title":["Autonomic reactivity to mental stress is associated with cardiovascular mortality"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9729-1558","authenticated-orcid":false,"given":"Anish S","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiology, University of Utah , 30 North Mario Capecchi Dr, 3rd Floor North, Salt Lake City, UT 84112 ,","place":["USA"]},{"name":"Department of Medicine, Division of Cardiology, University of Illinois Chicago , 840 South Wood Street, Suite 1020N, MC 787, Chicago, IL 60612 ,","place":["USA"]},{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9054-0654","authenticated-orcid":false,"given":"Viola","family":"Vaccarino","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 ,","place":["USA"]},{"name":"Emory Clinical Cardiovascular Research Institute, Emory University , 1750 Haygood Dr NE, 2nd Floor, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasra","family":"Moazzami","sequence":"additional","affiliation":[{"name":"Emory Clinical Cardiovascular Research Institute, Emory University , 1750 Haygood Dr NE, 2nd Floor, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakaria","family":"Almuwaqqat","sequence":"additional","affiliation":[{"name":"Emory Clinical Cardiovascular Research Institute, Emory University , 1750 Haygood Dr NE, 2nd Floor, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 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GA 30322 ,","place":["USA"]},{"name":"Atlanta VA Medical Center , 1670 Clairmont Rd, Decatur, GA 30033 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad D","family":"Pearce","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Raggi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 ,","place":["USA"]},{"name":"Division of Cardiology, Department of Medicine, University of Alberta , 83 Ave NW Edmonton T6G2B7 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Douglas","family":"Bremner","sequence":"additional","affiliation":[{"name":"Atlanta VA Medical Center , 1670 Clairmont Rd, Decatur, GA 30033 ,","place":["USA"]},{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , 100 Woodruff Circle, Atlanta, GA 30322 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3313-0939","authenticated-orcid":false,"given":"Rachel","family":"Lampert","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine , 333 Cedar St., New Haven, CT 06510 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshed A","family":"Quyyumi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health, Emory University , 1518 Clifton Rd NE, Atlanta, GA 30322 ,","place":["USA"]},{"name":"Emory Clinical Cardiovascular Research Institute, Emory University , 1750 Haygood Dr NE, 2nd Floor, Atlanta, GA 30322 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