Elsevier

American Heart Journal

Volume 159, Issue 4, April 2010, Pages 612-619.e3
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women

https://doi.org/10.1016/j.ahj.2009.12.029Get rights and content

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 representative, prospective study using Cox proportional hazards model. Ten-thousand five-hundred nineteen men and 11,334 women were included, excluding those with preexisting coronary heart disease, angina, heart failure, or on antihypertensive therapy.

Results

The hazard ratios for cardiovascular disease (CVD) mortality for each 15 beats/min increase in RHR were 1.24 (1.11-1.40) in men and 1.32 (1.08-1.60) in women, adjusted for age, gender, total cholesterol, physical activity (categorical), SBP, body mass index, and high-density lipoprotein cholesterol. This relationship remained significant after exclusion of those with comorbidities and events occurring within first 2 years of observation. Relationship with coronary mortality was stronger and with total mortality was slightly weaker. Inclusion of nonfatal end points weakened the relationship.

Conclusions

A strong, graded, independent relationship between RHR and incident CVD was demonstrated. This was consistent in healthy men and women. We have clarified that the relationship is independent of SBP and that the temporal sequence would be compatible with a causal relationship. New findings include independence from both a validated measure of physical activity and comorbidities and the demonstration of a stronger effect for fatal than nonfatal events, supporting increased arrhythmogenicity of one of the mechanisms.

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.

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