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Original research article
Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population
  1. Xiao-jing Chen1,2,
  2. Salim Bary Barywani3,
  3. Per-Olof Hansson4,
  4. Erik Östgärd Thunström3,
  5. Annika Rosengren5,
  6. Constantinos Ergatoudes3,
  7. Zacharias Mandalenakis6,
  8. Kenneth Caidahl7 and
  9. Michael Lx Fu3
  1. 1Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Cardiology, Sichuan University West China Hospital, Chengdu, China
  3. 3Department of Cardiology, Sahlgrenska Academy. University of Gothenburg, Gothenburg, Sweden
  4. 4Department of Molecular and Clinical Medicine/ Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
  5. 5Sahlgrenska University Hospital Ostra, Goteborg, Sweden
  6. 6Molecular and Clinical Medicine, Goteborgs universitet Sahlgrenska Akademin, Goteborg, Sweden
  7. 7Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Salim Bary Barywani; salim.barywani{at}


Background Resting heart rate (RHR), a known cardiovascular risk factor, changes with age. However, little is known about the association between changes in RHR and the risk of cardiovascular events. The purpose of this study was therefore to assess the impact of RHR at baseline, and the change in RHR over time, on the risk of all-cause death and cardiovascular events.

Design A random population sample of men born in 1943 who were living in Gothenburg, Sweden was prospectively followed for a 21-year period.

Methods Participants were examined three times: first in 1993 and then re-examined in 2003 and 2014. At each visit, a clinical examination, an ECG and laboratory analyses were performed. Change in RHR between 1993 and 2003 was defined as a decrease if RHR decreased by 5 beats per minute (bpm), an increase if RHR increased by 5 bpm or stable if the RHR change was <4bpm).

Results Participants with a baseline RHR of >75 bpm in 1993 had about a twofold higher risk of all-cause death (HR 2.3, CI 1.2 to 4.7, p=0.018), cardiovascular disease (CVD) (HR 1.8, CI 1.1 to 3.0, p=0.014) and coronary heart disease (CHD) (HR 2.2, CI 1.1 to 4.5, p=0.025) compared with those with <55 bpm in 1993. Participants with a stable RHR between 1993 and 2003 had a 44% decreased risk of CVD (HR 0.56, CI 0.35 to 0.87, p=0.011) compared with participants with an increasing RHR. Furthermore, every beat increase in heart rate from 1993 was associated with a 3% higher risk for all-cause death, 1% higher risk for CVD and 2% higher risk for CHD.

Conclusion High RHR was associated with an increased risk of death and cardiovascular events in men from the general population. Moreover, individuals with an increase in RHR between 50 and 60 years of age had worse outcome.

  • resting heart rate
  • all-cause death
  • cardiovascular events
  • risk factor
  • population-based study

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  • Contributors SBB, XC, P-OH, ET, AR, CE, ZM, KG and MLF conceived of the presented idea. SBB, XC and MLF developed the theory and performed the computations. SBB, XC and MLF verified the analytical methods. All authors discussed the results and contributed to the final manuscript. SBB is responsible for the overall content as guarantor.

  • Funding The study was financed by grants from the Swedish state under the agreement between the 14 Swedish government and the county councils, the ALF agreement (73400, 447561, 726481), the 15 Swedish Heart and Lung Foundation and the Swedish Research Council (SIMSAM).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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