Resting Heart Rate Pattern During Follow-Up and Mortality in Hypertensive Patients

ObjectiveMost studies investigating the association between resting heart rate (RHR) and mortality have focused on cardiovascular disease (CVD) mortality, and measured RHR at only one time point. We aimed to assess associations of RHR and changes in RHR over approximately a decade with overall and cause-specific mortality.MethodsWe used data from participants in the Melbourne Collaborative Cohort Study with RHR measures at baseline (1990–1994; n=41 386; 9846 deaths) and at follow-up (2003–2007; n=21 692; 2818 deaths). RHR measures were taken by trained staff, using Dinamap monitors. Cox models were used to estimate HR and 95% CI for the associations between RHR and mortality. Vital status and cause of death were ascertained until August 2015 and December 2013, respectively.ResultsAfter adjustment for confounders, including blood pressure and known medical conditions but not arrhythmias or atrial fibrillation, RHR was associated with a higher risk of death of similar magnitude for CVD (HR per 10 beats per minute (bpm)=1.11, 95% CI 1.07 to 1.16), cancer (HR=1.10, 95% CI 1.06 to 1.13) and other causes (HR=1.20, 95% CI 1.16 to 1.25). Higher mortality was observed for most cancer sites, including breast (HR=1.16, 95% CI 1.03 to 1.31), colorectal (HR=1.18, 95% CI 1.08 to 1.29), kidney (HR=1.27, 95% CI 1.03 to 1.57) and lung cancer (HR=1.19, 95% CI 1.10 to 1.29). Temporal increases in RHR were associated with higher mortality, particularly for individuals whose RHR increased by more than 15 bpm.ConclusionsRHR and changes in RHR over a decade are associated with mortality risk, including from causes other than CVD such as breast, colorectal or lung cancer. Monitoring of RHR may have utility in identifying individuals at higher mortality risk.

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Risk Factors for Longitudinal Resting Heart Rate and Its Associations With Cardiovascular Outcomes in the DCCT/EDIC Study

10.2337/figshare.13660904.v1 ◽

2021 ◽

Author(s):

Sareh Keshavarzi ◽

Barbara H. Braffett ◽

Rodica Pop-Busui ◽

Trevor J. Orchard ◽

Elsayed Z. Soliman ◽

...

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Treatment Group ◽

Intensive Therapy ◽

Resting Heart Rate ◽

Lower Heart Rate ◽

Cvd Risk ◽

Significant Group

Background: Individuals with diabetes have higher resting heart rate compared to those without, which may predict long-term cardiovascular (CVD) risk. Using data from the DCCT/EDIC study, we evaluated whether the beneficial effect of intensive vs. conventional diabetes therapy on heart rate persisted, the factors mediating the differences in heart rate between treatment groups, and the effects of heart rate on future CVD risk. Research Design and Methods: Longitudinal changes in heart rate, from annual electrocardiograms over 22 years of EDIC follow-up, were evaluated in 1402 participants with type 1 diabetes. Linear mixed models were used to assess the effect of DCCT treatment group on mean heart rate over time and Cox proportional hazards models were used to estimate the effect of heart rate on CVD risk during DCCT/EDIC. Results: At DCCT closeout, participants were 33±7 years old, 52% male, diabetes duration 12±5 years, and HbA1c 7.4±1.2% (intensive) and 9.1±1.6% (conventional). Through EDIC, participants in the intensive group had significantly lower heart rate compared to the conventional group. While significant group differences in heart rate were fully attenuated by DCCT/EDIC mean HbA1c, higher heart rate predicted CVD and major adverse cardiovascular events (MACE) independent of other risk factors. Conclusion: After 22 years of follow-up, former intensive vs. conventional therapy remained significantly associated with lower heart rate, consistent with the long-term beneficial effects of intensive therapy on CVD. DCCT treatment group effects on heart rate were explained by differences in DCCT/EDIC mean HbA1c.

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Relation between resting heart rate and the risk of ventricular tachyarrhythmias in MADIT-RIT

EP Europace ◽

10.1093/europace/euz353 ◽

2020 ◽

Vol 22 (2) ◽

pp. 281-287

Author(s):

Roy Beinart ◽

Valentina Kutyifa ◽

Scott McNitt ◽

David Huang ◽

Mehmet Aktas ◽

...

Keyword(s):

Heart Rate ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Continuous Measure ◽

Ventricular Tachyarrhythmias ◽

Resting Heart Rate ◽

Icd Therapy ◽

Kaplan Meier ◽

Life Threatening

Abstract Aims To explore the association between resting heart rate (RHR) and ventricular tachyarrhythmias (VTA) events among patients who were enrolled in MADIT-RIT. Methods and results Multivariate Cox proportional hazards regression modelling was employed to evaluate the association between baseline RHR [dichotomized at the lower quartile (≤63 b.p.m.) and further assessed as a continuous measure] and the risk for any VTA, fast VTA (>200 b.p.m.), and appropriate implantable cardioverter-defibrillator (ICD) therapy, among 1500 patients who were enrolled in MADIT-RIT. Kaplan–Meier survival analysis showed that at 2 years of follow-up the rate of any VTA was significantly lower among patients with low baseline RHR (≤63 b.p.m.) as compared with faster RHR (11% vs. 19%, respectively; P = 0.001 for the overall difference during follow-up). Similar results were shown for the association with the rate of fast VTA (8% vs. 14%, respectively; P = 0.016), and appropriate ICD therapy (10% vs. 18%, respectively; P = 0.004). Multivariate analysis, after adjustment for medical therapy, showed that low baseline RHR was associated with a significant 45% (P = 0.002) reduction in the VTA risk as compared with faster baseline RHRs. When assessed as a continuous measure, each 10 b.p.m. decrement in RHR was associated with a corresponding 13% (P = 0.014) reduction in the VTA risk. Conclusion In MADIT-RIT, low RHR was independently associated with a lower risk for life-threatening arrhythmic events. These findings suggest a possible role for RHR for improved selection of candidates for ICD therapy.

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Abstract P367: Association Between Resting Heart Rate and Progression of Valvular Calcification

Circulation ◽

10.1161/circ.137.suppl_1.p367 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Kojo Amoakwa ◽

Oluwaseun E Fashanu ◽

Martin Tibuakuu ◽

Di Zhao ◽

Eliseo Guallar ◽

...

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Cardiac Computed Tomography ◽

Resting Heart Rate ◽

Annual Change ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Cut Points ◽

Valvular Calcification

Background: Mitral annular calcification (MAC) and aortic valvular calcification (AVC) are progressive and linked to increased cardiovascular disease (CVD) morbidity and mortality. Few known modifiable risk factors associated with the progression of MAC and AVC exist. Resting heart rate (RHR) is an established independent risk factor for CVD. Due to the potential hemodynamic effects of RHR on development or progression of valve calcification, we assessed whether RHR is associated with the incidence and progression of MAC and AVC in a community-based cohort free of CVD and atrial fibrillation at baseline. Methods: We obtained RHR from baseline 12-lead electrocardiograms of 5,498 MESA cohort participants. We studied RHR as a continuous variable (per 1 SD increment) and also categorized at clinical cut points of < 60, 60 - 69, 70 - 79, and ≥ 80 bpm. MAC and AVC were quantified (using Agatston scoring) from cardiac computed tomography scans obtained at baseline and at follow-up examinations 2 or 3. We examined associations between RHR and incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker medication use. We used progressively adjusted parametric survival models for incident MAC/AVC and linear regression models for annual change in MAC/AVC. Results: At baseline, participants had a mean age of 62±10 years and mean RHR of 63±10 bpm; 12.3% and 8.9% had prevalent AVC and MAC [Agatston Units (AU) >0], respectively. Over a median follow up time of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Hazard Ratio 1.18 (95% CI 1.03-1.36)], but not incident AVC. However, RHR (per 10 bpm) was associated with AVC progression [β coeff 1.62 (0.45-2.80) AU/year], but not MAC progression. The association of RHR on annual change in AVC was modified by age and sex (p-interactions 0.006 and <0.02, respectively) but not race/ethnicity. Each 10 bpm higher RHR was significantly associated with AVC progression for age > 62 years [β coeff 2.94 (0.55, 5.34) AU/year] and male sex [3.49 (1.31, 5.67) AU/year]. The association between RHR and AVC progression was not significant for age ≤ 62 or female sex. Similar trends were seen using clinical cut-points for RHR. Conclusion: Higher RHR predicted incident MAC and AVC progression independent of traditional CVD risk factors. Future studies are needed to determine whether this association is causal and whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium progression.

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Abstract P021: Association Of Resting Heart Rate With All-cause And Cardiovascular Mortality: Sprint

Circulation ◽

10.1161/circ.143.suppl_1.p021 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Steven J Mould ◽

Elsayed Z Soliman ◽

Yashashwi Pokharel ◽

Elijah Beaty ◽

Prashant Bhave ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Channel Blockers ◽

Resting Heart Rate ◽

Autonomic Tone

Introduction: Elevated resting heart rate (RHR) has been shown to be associated with both all-cause and cardiovascular mortality. Prior studies have provided conflicting estimates of the strength of each association. To explore the relationship between RHR and competing mortality risks, we sought to compare the association between RHR and cardiovascular and non-cardiovascular mortality among participants in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: Eligible SPRINT participants had baseline RHR, longitudinal follow-up, and were not using beta blockers or non-dihydropyridine calcium channel blockers. Mortality was classified by a treatment-blinded adjudication committee as cardiovascular if secondary to coronary heart disease, stroke, sudden cardiac death, or congestive heart failure. Multivariable Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CI) for cardiovascular and non-cardiovascular mortality, separately, associated with a 10 beats per minute increase in RHR. Results: Among 5,571 eligible SPRINT participants (67.1 ± 9.4 years, 33.8% female, 63.8% white, mean RHR 70.4±11.8 beats per minute) over a median 3.8 years of follow-up, there were 56 cardiovascular deaths and 176 non-cardiovascular deaths. In models adjusted for age, sex, race, prior cardiovascular disease, smoking, systolic blood pressure, creatinine, total cholesterol, high-density lipoprotein cholesterol, and trial treatment assignment, higher RHR (per ten beat-per-minute increase) was associated with both cardiovascular (HR 1.17, 95% CI 1.02-1.35) and non-cardiovascular mortality (HR 1.27, 95% CI 1.13-1.43). Conclusions: Elevated RHR was associated with both cardiovascular and non-cardiovascular mortality, suggesting that RHR may serve as a marker of both global health rather and cardiovascular health. Higher RHR may reflect imbalance in autonomic tone and further studies are needed to explore the mechanisms of these associations.4

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QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

Diabetologia ◽

10.1007/s00125-006-0483-1 ◽

2006 ◽

Vol 50 (1) ◽

pp. 186-194 ◽

Cited By ~ 60

Author(s):

C. Stettler ◽

A. Bearth ◽

S. Allemann ◽

M. Zwahlen ◽

L. Zanchin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Heart Rate ◽

Type 2 Diabetes Mellitus ◽

Qtc Interval ◽

Resting Heart Rate

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Walking Pace, Leisure Time Physical Activity, and Resting Heart Rate in Relation to Disease-Specific Mortality in London: 40 Years Follow-Up of the Original Whitehall Study. An Update of Our Work with Professor Jerry N. Morris (1910–2009)

Annals of Epidemiology ◽

10.1016/j.annepidem.2010.03.014 ◽

2010 ◽

Vol 20 (9) ◽

pp. 661-669 ◽

Cited By ~ 30

Author(s):

G. David Batty ◽

Martin J. Shipley ◽

Mika Kivimaki ◽

Michael Marmot ◽

George Davey Smith

Keyword(s):

Physical Activity ◽

Heart Rate ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Resting Heart Rate ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Disease Specific

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Associations of Resting Heart Rate and Intelligence With General and Specific Psychopathology: A Prospective Population Study of 899,398 Swedish Men

Clinical Psychological Science ◽

10.1177/2167702620961081 ◽

2021 ◽

pp. 216770262096108

Author(s):

Erik Pettersson ◽

Paul Lichtenstein ◽

Henrik Larsson ◽

Brian M. D’Onofrio ◽

Benjamin B. Lahey ◽

...

Keyword(s):

Heart Rate ◽

Externalizing Problems ◽

Factor Model ◽

General Factor ◽

Resting Heart Rate ◽

Criminal Convictions ◽

Correlated Factors ◽

Sensitivity To Punishment ◽

Internalizing And Externalizing

We examined longitudinal associations of resting heart rate (RHR) and general intelligence (IQ) with two psychopathology models (correlated factors and general factor model). RHR and IQ were measured during conscription (mean age = 18.23 years; N = 899,398 Swedish males). A correlated factors model of register-based outcomes (including 10 psychiatric diagnoses, criminal convictions, and prescription of anxiolytic medications; mean age at follow-up = 43.09 years) identified internalizing, externalizing, and psychotic dimensions; the general factor model additionally identified a general dimension. All correlated factors were inversely associated with IQ; however, the general factor model showed that several of these associations were attributable to general variance rather than specific variance. In both psychopathology models, RHR weakly but significantly predicted higher internalizing but lower externalizing problems. Intelligence might be a transdiagnostic risk factor for any form of psychopathology, and the internalizing and externalizing spectra might be differentiated by psychobiological processes related to sensitivity to punishment.

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