title: Association of educational status with heart rate recovery: a population-based propensity analysis.
abstract: OBJECTIVE
  An abnormally attenuated heart rate recovery after exercise is a predictor of mortality that is thought to reflect decreased parasympathetic activity. Lower educational level may be associated with automatic imbalance. We sought to assess the association of educational level with heart rate recovery.
  
  
  METHODS
  Among 5246 healthy adults from a population-based cohort who underwent exercise testing, 874 (17%) did not graduate from high school, 1823 (35%) completed high school, and 2549 (49%) attended at least some college. An abnormal heart rate recovery was defined as a difference of </=42 beats per minute between the peak heart rate and that after 2 minutes of recovery. Propensity scores were used to account for differences by educational status.
  
  
  RESULTS
  An abnormal heart rate recovery was more common among adults who did not graduate from high school compared with those who attended at least some college (50% [440/874] vs. 28% [701/2549]; odds ratio [OR]: 2.7; 95% confidence interval [CI]: 2.3 to 3.1; P <0.001). After using propensity scores, lower educational status remained associated with an abnormal heart rate recovery (OR = 1.9; 95% CI: 1.6 to 2.4; P <0.001). During 12-years of follow-up, there were 327 deaths. Poor educational status was associated with greater mortality (9% [80/874] vs. 6% [247/4372]; unadjusted hazard ratio [HR] = 1.9; 95% CI: 1.4 to 2.5; P <0.001). However, after accounting for age, sex, and heart rate recovery, educational status was a weaker predictor (HR = 1.3; 95% CI: 1.0 to 1.7).
  
  
  CONCLUSIONS
  Educational status is independently associated with an abnormal heart rate recovery.
authors.affiliation: Department of Internal Medicine (MHS), The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Shishehbor
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D004522:Educational Status; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012016:Reference Values; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013610:Tachycardia / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*