Clinical InvestigationCoronary Artery DiseaseElevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women
Section snippets
Aim
In this analysis, we aim to examine the relationship between RHR and CHD, CVD and total mortality and nonfatal myocardial infarction (MI) in the National FINRISK study. This extensive, standardized, prospective study provides enough information on potential confounders to clarify many of the inconsistencies outlined above and to establish whether there are gender differences in the relationship. In addition, we will examine the associations between RHR and other CV risk factors.
Study population
The National FINRISK study is a large prospective population-based observational study.31 Full methodological details have been described elsewhere.31 Briefly, collection of baseline data began in 1972. Subsequent studies began in 1977, 1982, 1987, 1992, 1997, 2002, and 2007. Random, representative population samples were drawn from population registers. Initially, those aged 30 to 59 years were recruited, this was extended in subsequent surveys with individuals 25 to 74 years recruited in 1997.
Results
This analysis is limited to the 28,047 individuals in the study years from 1982 onward (because HDL cholesterol was measured in these years). Exclusion of those with previous MI, angina, heart failure, or pharmacologic treatment of hypertension (4,978) and those with missing data left 10,519 men and 11,334 women. Baseline characteristics are shown in Table I. The median duration of follow-up was 12 years.
As shown in Table I, there was a trend toward higher total cholesterol levels, higher blood
Discussion
This analysis has clearly demonstrated the association between resting heart rate and CVD, CHD, and total mortality. We have confirmed the strength of the relationship. For example, in men, RHR >90 beats/min compared to RHR <60 beats/min was associated with an almost 2-fold increased risk of CVD mortality in men and 3-fold increased risk in women. This effect was independent and similar in magnitude to the risk associated with current smoking (data not shown). These estimates are similar to
Conclusion
This large prospective cohort study confirms the strong and graded relationship between RHR and CVD, CHD and total mortality end points. We have clarified a number of previously disputed issues relating to fulfillment of the causal criteria, specifically independence, appropriate temporal sequence, and the consistency of the relationship in women. We have demonstrated, for the first time that RHR is a risk factor independent of a validated measure of physical activity. In addition, we have
Acknowledgements
Competing interests: Prof Ian Graham has received an unrestricted educational grant from Servier.
Roles and responsibilities of the research team: all coauthors were involved in the design of the analyses. All coauthors were involved in the revising and finalizing of the article. E.V., T.L., and A.J. were involved in the collection of data and administration of the National FINRISK Study. MTC performed all of the statistical analyses and wrote the first draft of the article.
References (44)
- et al.
Heart rate and cardiovascular mortality: The Framingham Study
Am Heart J
(1987) - et al.
The predictive value of admission heart rate in patients with suspected or proven coronary artery disease
Eur Heart J
(1995) - et al.
Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction. Results of a two-year follow-up study
J Am Coll Cardiol
(1996) - et al.
Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial
Lancet
(2008) - et al.
Influence of heart rate on mortality among persons with hypertension: The Framingham Study
Am Heart J
(1993) - et al.
Resting heart rate in cardiovascular disease
JACC
(2007) - et al.
Resting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population
Am Heart J
(2004) - et al.
Prognostic value of home heart rate for cardiovascular mortality in the general population: the Ohasama study
Am J Hypertens
(2004) - et al.
Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial
Lancet
(2008) - et al.
Relation of heart rate and long-term (>20 years) death rate in initially healthy middle-aged men
Am J Cardiol
(2009)
Assessing cardiorespiratory fitness without performing exercise testing
Am J Prev Med
Effects of n-3 fatty acids from fish on premature ventricular complexes and heart rate in humans
Am J Clin Nutr
Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials
Am J Med
Rest heart rate and life expectancy
JACC
Heart rate as a prognostic factor for coronary heart disease and mortality: findings in three Chicago epidemiologic studies
Am J Epidemiol
Influence of heart rate on mortality in a French population: role of age, gender, and blood pressure
Hypertension
Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality: the Chicago Heart Association Detection Project in Industry
Am J Epidemiol
Pulse rate, coronary heart disease, and death: the NHAMES I Epidemiologic Follow-up Study
Am Heart J
Prognostic significance of exercise heart rate and blood pressure in middle-aged men
Hypertension
Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men
Br Heart J
Predicting sudden death in the population: The Paris Prospective Study
Circulation
Heart rate as a predictor of mortality: the MATISS project
Am J Pubic Health
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