Study design and population.

A total of 695 subjects were enrolled from the Mental Stress Ischemia Prognosis Study (MIPS),¹⁹ a prospective cohort study that enrolled patients with stable CAD between June 2011 and August 2014 from Emory University affiliated hospitals. Presence of CAD was defined either by an abnormal coronary angiogram showing evidence of atherosclerosis with at least luminal irregularities, previous percutaneous or surgical coronary revascularization, previous myocardial infarction (MI), or positive nuclear stress test. Exclusion criteria included acute coronary syndrome or decompensated heart failure (HF) in the previous two months, end-stage renal disease, and severe psychiatric conditions that would affect study assessments, such as schizophrenia. Clinical information, such as previous CAD events, risk factors, and current medication use were obtained using standardized questionnaires and chart reviews. The study protocol was approved by the Institutional Review Board of Emory University, and all subjects provided informed consent. Online Figure I illustrates the inclusion of final analytical sample involved in the study.