Real-life Psychological Experiences and Cardiac Autonomic Physiology among Survivors of a Myocardial Infarction in Midlife

Middle-aged women with ischemic heart disease have a higher burden of psychosocial factors compared with male counterparts. Data on daily life stress and autonomic physiology could help guide targeted interventions. We studied 302 individuals ≤ 61 years of age (129 women and 173 men) recently hospitalized for a myocardial infarction (MI). All underwent a 7-day home monitoring of mood and stress using ecological momentary assessments, with concomitant Holter monitoring for autonomic physiology. Deceleration capacity (DC), a prognostic marker of parasympathetic activity, was the primary autonomic outcome. Across the week of monitoring, women reported higher levels and variability of negative mood and stress than men, with no differences in positive mood. Women also exhibited significantly lower parasympathetic activity (the daily averaged of DC) compared with men. Heart rate variability was also lower. Among women, but not men, daily negative mood was inversely associated with lower DC: for each 1-log unit higher daily negative mood score DC declined 4.5% in women, with no change in men (p=0.02 for interaction). Women with early-onset MI 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 post-MI women.