Relation of Higher Resting Heart Rate to Risk of Cardiovascular Versus Noncardiovascular Death

Published on Apr 1, 2017in American Journal of Cardiology2.843
· DOI :10.1016/j.amjcard.2016.11.059
Lubna Alhalabi1
Estimated H-index: 1
Matthew J. Singleton2
Estimated H-index: 2
(Wake Forest University)
+ 3 AuthorsElsayed Z. Soliman50
Estimated H-index: 50
(Wake Forest University)
Higher resting heart rate (RHR) is associated with increased risk of all-cause and cardiovascular mortality, with some reports showing the magnitude of association with all-cause mortality being stronger than that with cardiovascular mortality. This suggests that RHR association with mortality may not be limited to cardiovascular death. We compared the association between RHR with cardiovascular and noncardiovascular mortality in 6,743 participants (mean age 58.7 years, 52% women, 48% non-Hispanic whites) from the Third National Health and Nutrition Examination Survey (NHANES-III) after excluding those on antiarrhythmic drugs or with missing data. RHR data were obtained from standard 12-lead electrocardiogram recorded on the NHANES participants during a physical examination. National Death Index was used to identify the date and cause of death. Multivariable Cox proportional hazards analysis was used to calculate the hazard ratios (HRs) and 95% CIs for cardiovascular mortality and noncardiovascular mortality, separately, associated with 10 beats/min increase in RHR. During a median follow-up of 13.9 years, 906 cardiovascular deaths and 1,306 noncardiovascular deaths occurred. In models adjusted for age, gender, race, hypertension, diabetes, obesity, dyslipidemia, previous cardiovascular disease, smoking, cancer, chronic obstructive airway disease, thyroid disease, and serum creatinine, higher RHR was associated with increased risk of both cardiovascular mortality and noncardiovascular mortality with a relatively similar magnitude of risk (HR 1.19, 95% CI 1.12 to 1.26 and HR 1.23, 95% CI 1.17 to 1.29, respectively). In conclusion, higher RHR is associated with both cardiovascular mortality and noncardiovascular mortality suggesting that RHR is probably a marker of overall well-being rather than a marker of cardiovascular health.
  • References (29)
  • Citations (9)
📖 Papers frequently viewed together
7 Citations
10 Citations
9 Authors (Xiaojing Chen, ..., Michael Fu)
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Dongfeng Zhang (Qingdao University)H-Index: 18
#2Xiaoli Shen (Qingdao University)H-Index: 1
Last. Xin Qi (Qingdao University)H-Index: 1
view all 3 authors...
Background: Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population. Methods: We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-spe...
71 CitationsSource
#1Kim Fox (Imperial College London)H-Index: 23
#2Ian FordH-Index: 108
Last. Roberto FerrariH-Index: 81
view all 6 authors...
BACKGROUND An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate–reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per minute or more. METHODS We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease...
253 CitationsSource
#1Magnus T. Jensen (Copenhagen University Hospital)H-Index: 13
#2Jacob L. Marott (Copenhagen University Hospital)H-Index: 14
Last. Gorm B. Jensen (Copenhagen University Hospital)H-Index: 74
view all 5 authors...
Aims: To investigate the association between resting heart rate (RHR) and markers of chronic low-grade inflammation. Also, to examine whether elevated resting heart rate is independently associated with cardiovascular and all-cause mortality in the general population, or whether elevated RHR is merely a marker of chronic low-grade inflammation.Methods and results: A group of 6518 healthy subjects from the the Danish general population were followed for 18 years during which 1924 deaths occurred....
79 CitationsSource
#1Karl Swedberg (University of Gothenburg)H-Index: 117
#2Michel KomajdaH-Index: 74
Last. Luigi TavazziH-Index: 100
view all 8 authors...
Summary Background Chronic heart failure is associated with high mortality and morbidity. Raised resting heart rate is a risk factor for adverse outcomes. We aimed to assess the effect of heart-rate reduction by the selective sinus-node inhibitor ivabradine on outcomes in heart failure. Methods Patients were eligible for participation in this randomised, double-blind, placebo-controlled, parallel-group study if they had symptomatic heart failure and a left-ventricular ejection fraction of 35% or...
1,361 CitationsSource
#1Michael BöhmH-Index: 119
#2Karl Swedberg (University of Gothenburg)H-Index: 117
Last. Luigi TavazziH-Index: 100
view all 8 authors...
Summary Background Raised resting heart rate is a marker of cardiovascular risk. We postulated that heart rate is also a risk factor for cardiovascular events in heart failure. In the SHIFT trial, patients with chronic heart failure were treated with the selective heart-rate-lowering agent ivabradine. We aimed to test our hypothesis by investigating the association between heart rate and events in this patient population. Methods We analysed cardiovascular outcomes in the placebo (n=3264) and iv...
543 CitationsSource
#2Erkki Vartiainen (National Institute for Health and Welfare)H-Index: 83
Last. Ian GrahamH-Index: 65
view all 6 authors...
Background Elevated resting heart rate (RHR) is known to be associated with reduced survival but inconsistencies remain, including lack of significance in most studies of healthy women, lack of independence from systolic blood pressure (SBP) in some, and the suggestion that RHR is merely functioning as a marker of physical inactivity or other comorbidities. We aimed to clarify these inconsistencies. Methods We analyzed the effect of RHR on end points in the National FINRISK Study; a representati...
238 CitationsSource
#1Aage Tverdal (FHI: Norwegian Institute of Public Health)H-Index: 52
#2Vidar Hjellvik (FHI: Norwegian Institute of Public Health)H-Index: 12
Last. Randi Selmer (FHI: Norwegian Institute of Public Health)H-Index: 45
view all 3 authors...
Aim To study the relationship between heart rate and (a) all deaths and (b) cardiovascular deaths in a large cohort of middle-aged Norwegian men and women. Methods and results A prospective study of participants in cardiovascular surveys that were carried out in 1985–1999 and covered men and women aged 40–45 years in all counties except the capital, Oslo. In total, 180 353 men and 199 490 women aged 40–45 years without cardiovascular history or diabetes accrued 4 775 683 years of follow-up. Ther...
93 CitationsSource
#1Simon Thackray (Castle Hill Hospital)H-Index: 18
#2Justin GhoshH-Index: 8
Last. JohnGFClelandH-Index: 115
view all 9 authors...
Background β-Blockers are effective for the treatment of heart failure, but their mechanism of action is unresolved. Heart rate reduction may be a central mechanism or a troublesome side effect. Methods A randomized, double-blind, parallel group study comparing chronic higher-rate (80 pulses per minute) with lower-rate (60 pulses per minute) pacing in pacemaker-dependent patients with symptomatic left ventricular (LV) systolic dysfunction, receiving β-blockers. Gated radionuclide ventriculograph...
71 CitationsSource
#1JanssenIan (Queen's University)H-Index: 73
#2Peter T. Katzmarzyk (Queen's University)H-Index: 85
Last. Steven N. BlairH-Index: 142
view all 4 authors...
Background Clinical measures that are used to identify risk for specific diseases may also help physicians predict overall mortality risk in their patients. This study derived and validated a clinical scoring system that can be used to predict all-cause mortality risk in men using age, resting heart rate, blood pressure, total cholesterol, HDL-cholesterol, triglycerides, diabetes, obesity, smoking status, and cardiorespiratory fitness categories. Methods This was a cohort-based prospective study...
32 CitationsSource
background Changes in heart rate during exercise and recovery from exercise are mediated by the balance between sympathetic and vagal activity. Since alterations in the neural control of cardiac function contribute to the risk of sudden death, we tested the hypothesis that among apparently healthy persons, sudden death is more likely to occur in the presence of abnormal heart-rate profiles during exercise and recovery. methods A total of 5713 asymptomatic working men (between the ages of 42 and ...
771 CitationsSource
Cited By9
#1Nasheeta Peer (South African Medical Research Council)H-Index: 18
#2Carl LombardH-Index: 56
Last. N. S. Levitt (UCT: University of Cape Town)H-Index: 13
view all 4 authors...
This study determined the associations of resting heart rate (RHR) with cardiovascular disease risk factors (CVDRF) in 25–74-year-old black South Africans. This cross-sectional study determined CVDRF by administered questionnaires, clinical measurements and biochemical analyses, including oral glucose tolerance tests. Multivariable linear regression models determined the associations of rising RHR with CVDRF. The basic model comprised age, gender, urbanisation, problematic alcohol use, daily cig...
#1Sarah Stark Casagrande (Silver Spring Networks)H-Index: 9
#2Catherine C. Cowie (NIH: National Institutes of Health)H-Index: 45
Last. Rodica Pop-Busui (UM: University of Michigan)H-Index: 40
view all 6 authors...
CONTEXT: Evidence suggests that heart rate (HR) is a prognostic factor for cardiovascular disease (CVD), for which persons with diabetes are at increased risk. OBJECTIVE: The objective of this article is to determine the association between HR and glycemic status in a nationally representative sample of US adults, and, among adults with diagnosed diabetes, the association between HR and hemoglobin A1c (HbA1c) level. DESIGN: A cross-sectional study was conducted. SETTING: The setting of this stud...
#1Bindu ChamarthiH-Index: 12
#2Aaron I. Vinik (EVMS: Eastern Virginia Medical School)H-Index: 66
Last. Anthony H. CincottaH-Index: 16
view all 4 authors...
Objective: Sympathetic nervous system (SNS) overactivity is a risk factor for insulin resistance and cardiovascular disease (CVD). We evaluated the impact of bromocriptine-QR, a dopamine-agonist antidiabetes medication, on elevated resting heart rate (RHR) (a marker of SNS overactivity in metabolic syndrome), blood pressure (BP) and the relationship between bromocriptine-QR's effects on RHR and HbA1c in type 2 diabetes subjects. Design and Subjects: RHR and BP changes were evaluated in this post...
Previous studies evaluating associations between resting heart rate (RHR) and cancer-related mortality/prognosis have yielded conflicting results. We investigated whether elevations in RHR are associated with colorectal cancer (CRC). We conducted a case-controlled study involving 1241 CRC patients and 5909 cancer-free controls from the Korean National Health and Nutrition Examination Survey. After propensity score (PS) matching, 1207 CRC patients and 1207 matched controls were analyzed. Associat...
#1Sangsang Li (Zhengzhou University)
#2Bingxin Guo (Zhengzhou University)
Last. Songhe Shi (Zhengzhou University)
view all 7 authors...
This study aimed to evaluate the role of the triglyceride (triacylglycerol) glucose (TyG) index in predicting and mediating the development of cardiovascular disease (CVD). This cohort study included 6078 participants aged over 60 years who participated in a routine health check-up programme from 2011 to 2017. The competing risk model, cox regression model and multimediator analyses were performed. TyG was calculated as ln [fasting triglyceride (mg/dl) × fasting plasma glucose (mg/dl)/2]. During...
#1V Velle‐Forbord (NTNU: Norwegian University of Science and Technology)H-Index: 1
#2Ragnhild Bergene Skråstad (NTNU: Norwegian University of Science and Technology)H-Index: 6
Last. Eszter Vanky (NTNU: Norwegian University of Science and Technology)H-Index: 19
view all 6 authors...
1 CitationsSource
#1Mi Kyung Lee (Yonsei University)H-Index: 20
#2Dong Hoon Lee (Harvard University)H-Index: 15
Last. Justin Y. Jeon (Yonsei University)H-Index: 27
view all 5 authors...
Abstract Background Higher resting heart rate (RHR) was associated with poor prognosis in breast cancer survivors, but the mechanism underlying such association has not been fully studied. We investigated the association between RHR and metabolic risk factors in stage I-III breast cancer survivors. Methods Among 11,013 women diagnosed with breast cancer between 2005 and 2013 at the Severance hospital in Seoul, Korea, a total of 4980 patients met our inclusion criteria for the final analysis. Mul...
1 CitationsSource
#1Emi Yuda (Nagoya City University)H-Index: 5
#2Yutaka Yoshida (Nagoya City University)H-Index: 6
Last. Junichiro Hayano (Nagoya City University)H-Index: 39
view all 3 authors...
Using Allostatic State Mapping by Ambulatory ECG Repository (ALLSTAR) 24-h ECG big data, we investigated the effects of the time of sleep during the day on the occurrence time and value of basal heart rate (BHR), i.e., the minimum heart rate of the day. We found that the timing of BHR shifts slightly but significantly with the time of sleep (P < 0.0001); BHR occurs at 03:18 for nighttime sleepers on average, while it occurs at 02:35 for evening sleepers and 01:30 for daytime sleepers. The level ...
1 CitationsSource
1 CitationsSource
#1Marijana Tadic (Charité)H-Index: 16
#2Cesare Cuspidi (University of Milan)H-Index: 44
Last. Guido Grassi (University of Milano-Bicocca)H-Index: 77
view all 3 authors...
6 CitationsSource