The Cardiovascular Conundrum in LGB individuals: Hemodynamic effects of Minority Stress and emotion suppression

The “Cardiovascular Conundrum” describes an unexpected autonomic configuration—elevated vagally mediated heart rate variability (HRV) co-occurring with increased total peripheral resistance (TPR)—alongside a predominantly vascular, and thus more dysfunctional, hemodynamic profile. This pattern has been previously reported in African American (AA) individuals and interpreted either as genetically influenced or as the result of repeated exposure to discrimination and habitual emotional suppression. To examine whether similar mechanisms emerge in another minoritized group, we recruited 44 LGB adults and 46 heterosexual controls, matched for age and sex, and assessed their physiological responses at rest and while recalling a stressful discriminatory experience. At baseline, LGB participants showed the same paradoxical autonomic signature documented in AA individuals, exhibiting higher HRV (d =.31), higher TPR (d =.36), and a more vascular hemodynamic profile characterized by greater TPR and lower cardiac output (CO) (d =.40), than heterosexual participants. Participants were subsequently assigned to either a free-coping control condition or to an emotional suppression condition, in which they were instructed to inhibit negative emotional expressions during a 10-minute recovery phase. Across both conditions, heterosexual participants displayed a myocardial response pattern, marked by higher CO (F = 4.59; η² =.05). In contrast, during free recovery LGB individuals showed a more vascular profile, with significantly higher TPR (d =.73). However, when instructed to suppress their emotions, the group difference was no longer present: heterosexual participants also shifted toward a vascular response, mirroring the pattern observed in the LGB group. These findings indicate that emotion-regulation processes—particularly suppression—play a central role in the elicitation of the Cardiovascular Conundrum. Replicating this autonomic configuration in another marginalized group further supports the hypothesis that minority stress becomes biologically embedded. The results underscore the need for health policies and interventions aimed at mitigating the physiological impact of discrimination.