Real‐Life Psychological Experiences and Cardiac Autonomic Physiology Among Survivors of a Myocardial Infarction in Midlife

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Abstract
Background: Young and middle‐aged women with ischemic heart disease have a higher burden of psychosocial factors compared with male counterparts. They also have worse morbidity and mortality, despite less atherosclerotic burden. Data on daily life stress and autonomic physiology could help guide targeted interventions. Methods: We studied 302 individuals ≤61 years of age recently hospitalized for a myocardial infarction. All underwent a 7‐day home monitoring of mood and stress using ecological momentary assessments, with concomitant Holter monitoring for autonomic physiology. Deceleration capacity, a prognostic marker of parasympathetic activity, was the primary autonomic outcome; heart rate variability was also examined. Results: The sample was 43% women with mean age of 51 years (SD, 7 years). Across the week of monitoring, women reported higher levels of negative mood and stress than men. Women also exhibited significantly lower parasympathetic activity (daily average of deceleration capacity) than men; heart rate variability was also lower. Among women, daily negative mood was inversely associated with lower deceleration capacity: for each 1‐log unit higher daily negative mood score, deceleration capacity declined 4.5% in women, but among men, the difference was close to zero: 0.5% ( P =0.02 for interaction). Adjustment for other risk factors did not materially affect the associations. A similar pattern of results was observed for heart rate variability metrics. Conclusions: Young and middle‐aged women who recently survived a myocardial infarction have more parasympathetic withdrawal than men in daily life, especially during moments of negative mood. These results underscore the need for greater attention to psychosocial management in women after myocardial infarction.

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